Rigidity and primary motoneuron damage in tetanus

Synaptic structural modification following changes in activity induced by tetanus neurotoxin in cat abducens neurons

A low or a high dose of tetanus neurotoxin (TeNT) injected in the lateral rectus muscle of the cat causes respectively, functional block of inhibitory synapses only or of both inhibitory and excitatory synapses simultaneously in abducens neurons (González-Forero et al. [2003] J. Neurophysiol. 89:1878-1890). As a consequence, neuronal firing activity increases (at low dose) or decreases (at high dose). We investigated possible structural modifications of inhibitory synapses in response to these activity alterations induced by TeNT. We used immunofluorescence against postsynaptic (gephyrin) and presynaptic (vesicular gamma-aminobutyric acid [GABA] transporter [VGAT]) markers of inhibitory synapses in combination with cell type markers for abducens motoneurons (calcitonin gene-related peptide or choline acetyltransferase) or internuclear neurons (calretinin). Seven days after high-dose treatment, the number of gephyrin-immunoreactive (IR) clusters per 100 microm of membrane perimeter was reduced on the soma of abducens motoneurons by 55.3% and by 60.1% on internuclear neurons. Proximal dendritic gephyrin-IR clusters were also significantly altered but to a lesser degree. Partial synaptic re-establishment was observed 15 days post injection, and complete recovery occurred after 42 days. Coverage by VGAT-IR terminals was reduced in parallel. In contrast, a low dose of TeNT caused no structural alterations. With electron microscopy we estimated that overall synaptic coverage was reduced by 40% in both types of neurons after a high dose of TeNT. However, F-type terminals with postsynaptic gephyrin were preferentially lost. Thus, the ratio between F and S terminals diminished from 1.28 to 0.39 on motoneurons and from 1.26 to 0.47 on internuclear neurons. These results suggest that the maintenance of proximal inhibitory synaptic organization on central neurons is best related to neuronal activity and not to the level of inhibitory synaptic function, which was equally blocked by the high or low dose of TeNT.

Cyclobenzaprine: effect on tonic vibration reflexes in local tetanus cat preparations

Local tetanus was induced by the injection of toxin into the gastrocnemius-soleus muscle of cats. After 48 hr, longitudinal vibration of the muscle was used to elicit a reflex contraction (tonic vibration reflex, TVR). In other experiments, electrical stimulation of various regions of the central nervous system served to elicit contraction of the muscle alone or to facilitate a vibration (150 mu at 300 Hz)-induced tonic vibration reflex. In contrast with normal animals, tonic vibration reflex responses in local tetanus preparations of decerebrate cats were augmented after transection of the spinal cord at Cl. In decerebrate local tetanus preparations, a dose-related reduction of tonic vibration reflex responses, induced at all frequencies and amplitudes of muscle vibration, was observed after doses of 0.5 to 3.5 mg/kg (i.v.) of cyclobenzaprine. Muscle contractions induced by stimulation of the medial reticular formation and facilitation of tonic vibration reflex responses were more sensitive to the action of cyclobenzaprine than were similar responses activated through stimulation of Deiters' lateral vestibular nucleus. In spinal preparations, tonic vibration reflex responses were only moderately reduced after similar doses of cyclobenzaprine. Contractions induced by stimulation of the spinal cord (T6) and facilitated tonic vibration reflex responses were only moderately reduced, whereas the post-stimulus-induced facilitations were considerably attenuated. Thus, experiments in local tetanus preparations support further the concept that the major site of action of cyclobenzaprine is supraspinal, whereas its action upon spinal structures contributes to its overall skeletal muscle-relaxant activity.

Cephalic tetanus studied with single fibre EMG

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.

Effect of tetanus toxin on the excitatory and the inhibitory post-synaptic potentials in the cat motoneurone

Tetanus toxin (100 mouse minimal lethal doses per kilogram) was injected into the medial gastrocnemius muscle of the cat. At various times thereafter, homonymous and heteronymous group Ia excitatory post-synaptic potentials (e.p.s.p.s), disynaptic reciprocal Ia inhibitory post-synaptic potentials (i.p.s.p.s) and post-synaptic potentials (p.s.p.s) produced by sural nerve stimulation were recorded in the medial gastrocnemius motoneurones. The duration of the after-hyperpolarization, the input resistance and the axonal conduction velocity of motoneurones were also measured. Homonymous Ia e.p.s.p.s remained normal until 72 h after toxin injection. However, 5 days after toxin injection, the amplitudes of Ia e.p.s.p.s. were significantly smaller than those in control animals (1.5 +/- 1.0 mV versus 5.6 +/- 2.7 mV; t test, P less than 0.001). Heteronymous Ia e.p.s.p.s produced by stimulation of the lateral gastrocnemius-soleus nerve 5 days after toxin injection were also significantly smaller than those in control animals (0.6 +/- 0.6 mV versus 2.5 +/- 1.5 mV; P less than 0.001). However, these heteronymous Ia e.p.s.p.s remained normal when the lateral gastrocnemius-soleus nerve was ligated and sectioned at the entry to those muscles just before the toxin injection. The ascending volleys, which are supposed to represent mainly the action potentials of the dorsal spinocerebellar tract and to be elicited monosynaptically by collaterals of group I afferents, were essentially the same in the left tetanic and right control sides up to 5 days after toxin injection. Ia i.p.s.p.s and the hyperpolarizing component of sural p.s.p.s could not be produced or were very small in motoneurones sampled later than 30 h after toxin injection. The duration of the after-hyperpolarization and the input resistance of motoneurones remained normal. Axonal conduction velocity of motoneurones measured 5 days after toxin injection was 89.4 +/- 12.7 m/s, and was significantly slower than that of control motoneurones (94.1 +/- 15.4 m/s) (P less than 0.005). Differences in the amplitude of group I incoming volleys between tetanic leg and contralateral control leg were not observed. These results suggest that tetanus toxin blocks excitatory synapses in the central nervous system as well as inhibitory synapses.

Permanent tetraplegia as a consequence of tetanus neonatorum. Evidence for widespread lower motor neuron damage

It is generally believed that no permanent neurological damage is found among survivors of tetanus neonatorum. Newborns dying shortly after the onset of tetanus also lack significant neurological abnormalities. In adults a variety of neuromuscular lesions have been reported; however, a uniform pathological picture is absent. We report a case of a newborn with severe tetanus in whom striking evidence of anterior horn neuronal damage was documented, causing permanent nonprogressive tetraplegia. We suggest that the mechanism responsible for this lesion involves the retrograde axoplasmic flow of tetanus toxin reaching the spinal cord via nerve endings in the infected umbilical cord stump.

Intraaxonal and extraaxonal transport of 125I-tetanus toxin in early local tetanus

The distribution of radioactivity in the sciatic nerve, the spinal ganglia, the ventral roots and the spinal cord was studied by means of histoautoradiography after injection of 125I-labelled tetanus toxin into gastrocnemius muscles of cats. In the sciatic nerve the major part of the radioactivity was found in the epineurium, but some axons also contained radioactivity. In the ventral root the radioactivity was strictly confined to a few axons; no radioactivity was found in other parts of the ventral root. In the spinal cord the radioactivity was confined to a few motoneurones where it was found in the soma as well as in the dendrites. Transient cooling of the ventral roots prevented the ascent of radioactivity into the spinal cord. Colchicine and vinblastine, after local application to the sciatic nerve, reduced the amount of radioactivity found in the ventral roots and in the spinal cord. However, the same effect was also obtained but to a lesser degree with lumicolchicine. It is concluded that the intraaxonal compartment is involved in the neural ascent of tetanus toxin into the spinal cord.