Comparison of the efficacy of magnesium sulphate and diazepam in the control of tetanus spasms

Tetanus though preventable through vaccination, it continues to be a major scourge and a common cause of death in developing countries. The objective of this study is to compare the efficacy of magnesium sulphate and diazepam in controlling the tetanus spasm. This was a randomized double blind controlled trial. A total of 42 patients with clinical diagnosis of tetanus, received continuous infusion of either magnesium sulphate or diazepam.  The outcome variable was cessation of spasm, uncontrollable spasm, death and presence of signs of magnesium toxicity or of excessive sedation of diazepam.  The knee jerk reflex was use to monitor magnesium sulphate overdose. Observations from the patients were entered into the data sheets and analysis was done using Epi info version 6.  A total of 42 patients were enrolled for the study, of whom 31(72.8%) were males and 11(27.2%). The age range of the patients was between 15 years and 70 years, with a mean age of 31.38 ± 14.89 years. Twenty one patients were randomly assigned to each arm of the trial.  The outcome variables measured were frequency of spasms, and duration of spasms, which were were similar in the first five hours of commencing the trials. The mean spasm frequency in the Magnesium sulphate group reduced from 4.1±1.6 spasms/h at the onset of studyto 0.13±0.05 spasms/h in the second week of trial compared to 3.4±1.5 spasms/h to 0.33±0.2 spasms/h in the diazepam group. This difference was statistically significant (p =0.010). The mean duration of spasm was also shorter in the magnesium sulphate group compared to the diazepam group (3.9±0.7 s versus 6.2±2.0 s) but without statistical significance (p value of 0.055). In magnesium sulphate group 11 (52.4%) patients survived and 10 (47.6%)patients died, while in the diazepam group 12 (57.14 %) patients survived, and 9 (42.86%) patients died during the trial . the Risk Ratio was 0.91( 95% C.I) . Magnesium sulphate is a suitable alternative to diazepam for the control of spasms in moderate tetanus.   Key words: Tetanus spasms, magnesium sulphate, diazepam.