Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1983 Sep;46(9):862–866. doi: 10.1136/jnnp.46.9.862

Cephalic tetanus studied with single fibre EMG.

J M Fernandez, M Ferrandiz, L Larrea, R Ramio, M Boada
PMCID: PMC1027573  PMID: 6311990

Abstract

In a case of cephalic tetanus with left facial spasms and trismus, the repetitive stimulation of the left facial nerve at 3, 10 and 20 Hz showed no facilitation or decrement. The amplitudes of the blink reflex were 50% lower on the affected side. The silent period of the masseter muscles was shortened. Concentric needle examination of the masseters and left facial EMG of the left frontalis muscle showed increased jitter and blocking in a significant proportion of the recorded potentials. Both jitter and blocking improved on higher innervation rates. All electrophysiological findings were normal on the second examination when the patient was asymptomatic. The single fibre EMG findings point to a presynaptic defect in the neuromuscular transmission in human tetanus.

Full text

PDF
862

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BROOKS V. B., CURTIS D. R., ECCLES J. C. The action of tetanus toxin on the inhibition of motoneurones. J Physiol. 1957 Mar 11;135(3):655–672. doi: 10.1113/jphysiol.1957.sp005737. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Barua A. R., Pal N. C., Ghose B. P. Tetanus myopathy. Indian J Med Res. 1976 May;64(5):673–679. [PubMed] [Google Scholar]
  3. Bizzini B. Tetanus toxin. Microbiol Rev. 1979 Jun;43(2):224–240. doi: 10.1128/mr.43.2.224-240.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bratzlavsky M., Vander Eecken H. La physiopathologie de l'hypertonie musculaire du tétanus. Rev Neurol (Paris) 1980;136(12):815–823. [PubMed] [Google Scholar]
  5. Bratzlavsky M., vander Eecken H. Medullary actions of tetanus toxin. An electrophysiological study in man. Arch Neurol. 1976 Nov;33(11):783–785. doi: 10.1001/archneur.1976.00500110051009. [DOI] [PubMed] [Google Scholar]
  6. CURTIS D. R. Pharmacological investigations upon inhibition of spinal motoneurones. J Physiol. 1959 Jan 28;145(1):175–192. doi: 10.1113/jphysiol.1959.sp006134. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Cull-Candy S. G., Lundh H., Thesleff S. Effects of botulinum toxin on neuromuscular transmission in the rat. J Physiol. 1976 Aug;260(1):177–203. doi: 10.1113/jphysiol.1976.sp011510. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Dastur F. D., Shahani M. T., Dastoor D. H., Kohiyar F. N., Bharucha E. P., Mondkar V. P., Kashyap G. H., Nair K. G. Cephalic tetanus: demonstration of a dual lesion. J Neurol Neurosurg Psychiatry. 1977 Aug;40(8):782–786. doi: 10.1136/jnnp.40.8.782. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Delwaide P. J. Electrophysiological exploration of the facial nerve. Electroencephalogr Clin Neurophysiol Suppl. 1978;(34):393–403. [PubMed] [Google Scholar]
  10. Diamond J., Mellanby J. The effect of tetanus toxin in the goldfish. J Physiol. 1971 Jul;215(3):727–741. doi: 10.1113/jphysiol.1971.sp009494. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Duchen L. W. Changes in motor innervation and cholinesterase localization induced by botulinum toxin in skeletal muscle of the mouse: differences between fast and slow muscles. J Neurol Neurosurg Psychiatry. 1970 Feb;33(1):40–54. doi: 10.1136/jnnp.33.1.40. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Duchen L. W. Changes in the electron microscopic structure of slow and fast skeletal muscle fibres of the mouse after the local injection of botulinum toxin. J Neurol Sci. 1971 Sep;14(1):61–74. doi: 10.1016/0022-510x(71)90130-4. [DOI] [PubMed] [Google Scholar]
  13. Duchen L. W. The effects of tetanus toxin on the motor end-plates of the mouse. An electron microscopic study. J Neurol Sci. 1973 Jun;19(2):153–167. doi: 10.1016/0022-510x(73)90159-7. [DOI] [PubMed] [Google Scholar]
  14. Duchen L. W. The local effects of tetanus toxin on the electron microscopic structure of skeletal muscle fibres of the mouse. J Neurol Sci. 1973 Jun;19(2):169–177. doi: 10.1016/0022-510x(73)90160-3. [DOI] [PubMed] [Google Scholar]
  15. Duchen L. W., Tonge D. A. The effects of tetanus toxin on neuromuscular transmission and on the morphology of motor end-plates in slow and fast skeletal muscle of the mouse. J Physiol. 1973 Jan;228(1):157–172. doi: 10.1113/jphysiol.1973.sp010078. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Ekstedt J., Nilsson G., Stalberg E. Calculation of the electromyographic jitter. J Neurol Neurosurg Psychiatry. 1974 May;37(5):526–539. doi: 10.1136/jnnp.37.5.526. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Elmqvist D., Lambert E. H. Detailed analysis of neuromuscular transmission in a patient with the myasthenic syndrome sometimes associated with bronchogenic carcinoma. Mayo Clin Proc. 1968 Oct;43(10):689–713. [PubMed] [Google Scholar]
  18. Eyrich K., Agostini B., Schulz A., Müller E., Noetzel H., Reichenmiller H. E., Wiemers K. Klinische und morphologische Beobachtungen von Skelettmuskelveränderungen beim Tetanus. Dtsch Med Wochenschr. 1967 Mar 24;92(12):530–540. doi: 10.1055/s-0028-1103678. [DOI] [PubMed] [Google Scholar]
  19. FOSTER J. A., MATZKE H. A. The neurocytology of experimental ascending tetanus. World Neurol. 1961 Jan;2:22–37. [PubMed] [Google Scholar]
  20. Farquharson R. G. Cephalic tetanus. Proc R Soc Med. 1972 Oct;65(10):875–876. doi: 10.1177/003591577206501033. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Gadoth N., Dagan R., Sandbank U., Levy D., Moses S. W. Permanent tetraplegia as a consequence of tetanus neonatorum. Evidence for widespread lower motor neuron damage. J Neurol Sci. 1981 Aug;51(2):273–278. doi: 10.1016/0022-510x(81)90105-2. [DOI] [PubMed] [Google Scholar]
  22. Garcia-Mullin R., Daroff R. B. Electrophysiological investigations of cephalic tetanus. J Neurol Neurosurg Psychiatry. 1973 Apr;36(2):296–301. doi: 10.1136/jnnp.36.2.296. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Habermann E., Dreyer F., Bigalke H. Tetanus toxin blocks the neuromuscular transmission in vitro like botulinum A toxin. Naunyn Schmiedebergs Arch Pharmacol. 1980 Feb;311(1):33–40. doi: 10.1007/BF00500299. [DOI] [PubMed] [Google Scholar]
  24. Henriksson K. G., Nilsson O., Rosén I., Schiller H. H. Clinical, neurophysiological and morphological findings in Eaton Lambert syndrome. Acta Neurol Scand. 1977 Aug;56(2):117–140. doi: 10.1111/j.1600-0404.1977.tb01417.x. [DOI] [PubMed] [Google Scholar]
  25. Kaeser H. E., Saner A. The effect of tetanus toxin on neuromuscular transmission. Eur Neurol. 1970;3(4):193–205. doi: 10.1159/000113971. [DOI] [PubMed] [Google Scholar]
  26. Kao I., Drachman D. B., Price D. L. Botulinum toxin: mechanism of presynaptic blockade. Science. 1976 Sep 24;193(4259):1256–1258. doi: 10.1126/science.785600. [DOI] [PubMed] [Google Scholar]
  27. Kryzhanovsky G. N. The mechanism of action of tetanus toxin: effect on synaptic processes and some particular features of toxin binding by the nervous tissue. Naunyn Schmiedebergs Arch Pharmacol. 1973;276(3-4):247–270. doi: 10.1007/BF00499880. [DOI] [PubMed] [Google Scholar]
  28. Kunze K. Neurophysiologische Befunde bei manifestem Tetanus. Langenbecks Arch Chir. 1969;325:903–909. doi: 10.1007/BF01256042. [DOI] [PubMed] [Google Scholar]
  29. Lambert E. H., Elmqvist D. Quantal components of end-plate potentials in the myasthenic syndrome. Ann N Y Acad Sci. 1971 Sep 15;183:183–199. doi: 10.1111/j.1749-6632.1971.tb30750.x. [DOI] [PubMed] [Google Scholar]
  30. Lundh H., Leander S., Thesleff S. Antagonism of the paralysis produced by botulinum toxin in the rat. The effects of tetraethylammonium, guanidine and 4-aminopyridine. J Neurol Sci. 1977 May;32(1):29–43. doi: 10.1016/0022-510x(77)90037-5. [DOI] [PubMed] [Google Scholar]
  31. Mamoli B., Ludin H. P. Electrophysiological investigations in a case of cephalic tetanus. J Neurol. 1977 Mar 21;214(4):251–255. doi: 10.1007/BF00316570. [DOI] [PubMed] [Google Scholar]
  32. Mellanby J., Thompson P. A. The effect of tetanus toxin at the neuromuscular junction in the goldfish. J Physiol. 1972 Jul;224(2):407–419. doi: 10.1113/jphysiol.1972.sp009902. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Price D. L., Griffin J. W., Peck K. Tetanus toxin: evidence for binding at presynaptic nerve endings. Brain Res. 1977 Feb;121(2):379–384. doi: 10.1016/0006-8993(77)90163-9. [DOI] [PubMed] [Google Scholar]
  34. Ricker K., Eyrich K. Elektrophysiologische Untersuchung der Facialislähmung bei Tetanus. J Neurol. 1974 Jun 27;207(2):155–163. doi: 10.1007/BF00594092. [DOI] [PubMed] [Google Scholar]
  35. Ricker K., Eyrich K., Zwirner R. Seltenere Formen von Tetanuserkrankung. Klinische und elektromyographische Untersuchung. Arch Psychiatr Nervenkr (1970) 1971;215(1):75–91. doi: 10.1007/BF00342824. [DOI] [PubMed] [Google Scholar]
  36. Risk W. S., Bosch E. P., Kimura J., Cancilla P. A., Fischbeck K. H., Layzer R. B. Chronic tetanus: clinical report and histochemistry of muscle. Muscle Nerve. 1981 Sep-Oct;4(5):363–366. doi: 10.1002/mus.880040502. [DOI] [PubMed] [Google Scholar]
  37. STRUPPLER A., STRUPPLER E., ADAMS R. D. Local tetanus in man. Its clinical and neurophysiological characteristics. Arch Neurol. 1963 Feb;8:162–178. doi: 10.1001/archneur.1963.00460020062005. [DOI] [PubMed] [Google Scholar]
  38. Schiller H. H., Stålberg E. Human botulism studied with single-fiber electromyography. Arch Neurol. 1978 Jun;35(6):346–349. doi: 10.1001/archneur.1978.00500300020003. [DOI] [PubMed] [Google Scholar]
  39. Schwab M. E., Suda K., Thoenen H. Selective retrograde transsynaptic transfer of a protein, tetanus toxin, subsequent to its retrograde axonal transport. J Cell Biol. 1979 Sep;82(3):798–810. doi: 10.1083/jcb.82.3.798. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Schwab M. E., Thoenen H. Electron microscopic evidence for a transsynaptic migration of tetanus toxin in spinal cord motoneurons: an autoradiographic and morphometric study. Brain Res. 1976 Mar 26;105(2):213–227. doi: 10.1016/0006-8993(76)90422-4. [DOI] [PubMed] [Google Scholar]
  41. Schwartz M. S., Stålberg E. Myasthenic syndrome studied with single fiber electromyography. Arch Neurol. 1975 Dec;32(12):815–817. doi: 10.1001/archneur.1975.00490540059007. [DOI] [PubMed] [Google Scholar]
  42. Shahani M., Dastur F. D., Dastoor D. H., Mondkar V. P., Bharucha E. P., Nair K. G., Shah J. C. Neuropathy in tetanus. J Neurol Sci. 1979 Oct;43(2):173–182. doi: 10.1016/0022-510x(79)90113-8. [DOI] [PubMed] [Google Scholar]
  43. Stalberg E. Clinical electrophysiology in myasthenia gravis. J Neurol Neurosurg Psychiatry. 1980 Jul;43(7):622–633. doi: 10.1136/jnnp.43.7.622. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Stålberg E., Trontelj J. V., Schwartz M. S. Single-muscle-fiber recording of the jitter phenomenon in patients with myasthenia gravis and in members of their families. Ann N Y Acad Sci. 1976;274:189–202. doi: 10.1111/j.1749-6632.1976.tb47685.x. [DOI] [PubMed] [Google Scholar]
  45. Stöckel K., Schwab M., Thoenen H. Comparison between the retrograde axonal transport of nerve growth factor and tetanus toxin in motor, sensory and adrenergic neurons. Brain Res. 1975 Nov 28;99(1):1–16. doi: 10.1016/0006-8993(75)90604-6. [DOI] [PubMed] [Google Scholar]
  46. Takano K., Henatsch H. D. Tension-extension diagram of the tetanus-intoxicated muscle of the cat. Naunyn Schmiedebergs Arch Pharmacol. 1973;276(3-4):421–436. doi: 10.1007/BF00499895. [DOI] [PubMed] [Google Scholar]
  47. Tarlov I. M. Rigidity and primary motoneuron damage in tetanus. Exp Neurol. 1974 Aug;44(2):246–254. doi: 10.1016/0014-4886(74)90062-4. [DOI] [PubMed] [Google Scholar]
  48. Vakil B. J., Singhal B. S., Pandya S. S., Irani P. F. Cephalic tetanus. Neurology. 1973 Oct;23(10):1091–1096. doi: 10.1212/wnl.23.10.1091. [DOI] [PubMed] [Google Scholar]
  49. WILSON V. J., DIECKE F. P., TALBOT W. H. Action of tetanus toxin on conditioning of spinal motoneurons. J Neurophysiol. 1960 Nov;23:659–666. doi: 10.1152/jn.1960.23.6.659. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES