Summary
Due to the use of advanced biochemical and neurophysiological techniques, our knowledge of the pathogenesis of tetanus has considerably improved during the past years.
Radio-labelled tetanus toxin has been traced within different nerves up to the anterior horn of the spinal cord where its localization down to the cellular level has been achieved. The distribution of labelled toxin depends on time and is influenced by antitoxin. The longer the duration of poisoning, the smaller the effect of antitoxin on the spinal enrichment of toxin and on the onset of toxic symptoms. The neural ascent of toxin into a spinal cord segment is enhanced by stimulation of the segmental nerves. Not only the motor nerves, but also sensory and vegetative nerves are able to serve as guide-rails for the toxin. The generalized tetanus has been understood as a special kind of local tetanus.
For a long time, disinhibition of the alpha motor system was considered to be the characteristic action of tetanus toxin, but recent evidence is in favour of an additional disinhibition of the gamma motor system (perhaps even preceding the alpha disinhibition) and also of the sympathetic spinal reflexes. This finding should have therapeutic implications. The detection of inhibitory effects of tetanus toxin on peripheral cholinergic synapses points again to the close similarity between tetanus toxin and botulinum A toxin.
The trends of future research will presumably lead to the elementary processes at the molecular and cellular level which are the basis of the clinical picture of tetanus.
Zusammenfassung
Unsere Kenntnis der Pathogenese des Wundstarrkrampfes hat sich durch Anwendung neuer biochemischer und neurophysiologischer Techniken innerhalb der letzten Jahre erheblich erweitert.
Radioaktiv markiertes Tetanustoxin wurde innerhalb verschiedener Nerven bis zu den Vorderhörnern des Rückenmarks verfolgt; dort wurde das Toxin z.T. noch auf cellulärer Ebene nachgewiesen. Die Verteilung des Toxins ist zeitabhängig und wird durch Antitoxin beeinflußt. Je weiter der Zeitpunkt der Vergiftung zurückliegt, desto geringer ist der Effekt des Antitoxins auf die Symptomatologie und die spinale Anreicherung des Toxins.
Die neurale Wanderung des Toxins wird durch Erregung des toxinhaltigen Nerven gefördert. Neben den motorischen Anteilen sind auch rein sensibel-sensorische und vegetative Nerven zur Weiterleitung des Toxins imstande. Der generalisierte Tetanus kann als eine Sonderform des lokalen Tetanus betrachtet werden.
Während bisher das klassische α-motorische System des Rückenmarks im Vordergrund der Untersuchungen stand, weisen neuere Arbeiten auf eine gleichzeitige, vielleicht sogar vorwiegende Enthemmung des γ-motorischen Systems hin. Außerdem werden vegetative Spinalreflexe enthemmt, was auch bei der Therapie bedacht werden sollte.
Die Hemmwirkung des Tetanustoxins auf periphere Synapsen weist auf große Ähnlichkeiten mit Botulinumtoxin hin, obwohl die Symptome am vergifteten Tier so verschieden sind.
Künftige Untersuchungen werden sich voraussichtlich mit der Wirkungsweise des Toxins auf molekularer und cellulärer Ebene befassen.
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Habermann, E., Wellhöner, H.H. Advances in tetanus research. Klin Wochenschr 52, 255–265 (1974). https://doi.org/10.1007/BF01468455
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DOI: https://doi.org/10.1007/BF01468455