Botulinum toxin A for treating muscular contractures in cephalic tetanus

Objective This study reports the use of botulinum toxin for treatment of muscle contractures in a patient with cephalic tetanus. Method Case report. Results An 80-year-old woman was diagnosed with cephalic tetanus, with contractures of the masseter, sternocleidomastoid, trapezius, and levator scapulae muscles. After one month of conventional treatment good recovery was observed, but with persistence of the contractures of the sternocleidomastoid, trapezius and levator scapulae. These contractures were treated with botulinum toxin A (75 IU in the right sternocleidomastoid, 25 IU in the right trapezius; one month later 50 IU in the left levator scapulae, 50 IU in the right levator scapulae, 75 IU in the left sternocleidomastoid; two months later 25 IU in the left trapezius). Full recovery was observed. Conclusions Local infiltration with botulinum toxin A appears to be an effective treatment for persistent muscle contracture in cephalic tetanus.