Norwegian Defense Research Establishment, N-2027 Kjeller, Norway.
Toxins (Basel). 2013 Jan 8;5(1):73-83. doi: 10.3390/toxins5010073.
Tetanus toxin, the product of Clostridium tetani, is the cause of tetanus symptoms. Tetanus toxin is taken up into terminals of lower motor neurons and transported axonally to the spinal cord and/or brainstem. Here the toxin moves trans-synaptically into inhibitory nerve terminals, where vesicular release of inhibitory neurotransmitters becomes blocked, leading to disinhibition of lower motor neurons. Muscle rigidity and spasms ensue, often manifesting as trismus/lockjaw, dysphagia, opistotonus, or rigidity and spasms of respiratory, laryngeal, and abdominal muscles, which may cause respiratory failure. Botulinum toxin, in contrast, largely remains in lower motor neuron terminals, inhibiting acetylcholine release and muscle activity. Therefore, botulinum toxin may reduce tetanus symptoms. Trismus may be treated with botulinum toxin injections into the masseter and temporalis muscles. This should probably be done early in the course of tetanus to reduce the risk of pulmonary aspiration, involuntary tongue biting, anorexia and dental caries. Other muscle groups are also amenable to botulinum toxin treatment. Six tetanus patients have been successfully treated with botulinum toxin A. This review discusses the use of botulinum toxin for tetanus in the context of the pathophysiology, symptomatology, and medical treatment of Clostridium tetani infection.
破伤风毒素是破伤风梭菌的产物，是引起破伤风症状的原因。破伤风毒素被摄取到下运动神经元的末梢，并通过轴突运输到脊髓和/或脑干。在这里，毒素经突触转运到抑制性神经末梢，抑制性神经递质的囊泡释放被阻断，导致下运动神经元去抑制。随后出现肌肉僵硬和痉挛，常表现为牙关紧闭、吞咽困难、角弓反张或呼吸、喉和腹肌的僵硬和痉挛，可能导致呼吸衰竭。相比之下，肉毒毒素主要停留在下运动神经元末梢，抑制乙酰胆碱释放和肌肉活动。因此，肉毒毒素可能减轻破伤风症状。可以通过将肉毒毒素注射到咬肌和颞肌来治疗牙关紧闭。这应该在破伤风病程早期进行，以降低发生吸入性肺炎、舌咬伤、厌食症和龋齿的风险。其他肌肉群也可以接受肉毒毒素治疗。已有 6 例破伤风患者成功接受了肉毒毒素 A 治疗。本文在讨论破伤风梭菌感染的病理生理学、症状学和医学治疗的背景下，探讨了肉毒毒素在破伤风中的应用。
