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Tetanus-induced rhythmic seizures mimicking the clinical and electroencephalographic presentation of status epilepticus
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  • Published on: 2 November 2022
    Tetanus-induced rhythmic seizures mimicking the clinical and electroencephalographic presentation of status epilepticus
    • Thomas P Bleck, Neurointensivist and clinical neurophysiologist Northwestern University

    I read this paper with great interest and congratulate the authors on consideration of tetanus in this case. I would point out that the EEG in Figure 1 was recorded with a low pass filter of 30 Hz, which could make EMG artifact look like the fast activity labeled as wicket spikes. If the raw EEG data are still available, examination at a low pass filter of 70 Hz would resolve the issue.

    Tetanus does not in and of itself alter consciousness, so one might infer that she had suffered hypoxia during her spasms to cause her coma on presentation, which likely led to the idea that this was status epilepticus. Her eventual cognitive recovery attests to the skill and persistence of her medial team.

    Culturing C. tetanii from a wound does not prove the diagnosis of tetanus, as the spores are ubiquitous, and only antitetanus antibodies from vaccination prevent the disease. However, I have no doubt about the diagnosis on clinical grounds. Did she receive tetanus toxoid in addition to human tetanus immune globulin? There are unfortunately cases of recurrent tetanus if active immunization is not pursued.

    Ref: Birch TB, Bleck TP. Tetanus (Clostridium tetani). In Bennett JE, Dolin R, Blaser MJ (eds), Mandell, Douglas, and Bennett’s Principles and practice of infectious diseases (ed 9). Philadelphia: Elsevier, 2020, pp. 2948 – 2953.

    Conflict of Interest:
    None declared.