Abrupt withdrawal from intrathecal baclofen: Recognition and management of a potentially life-threatening syndrome

Coffey, Robert J.; Edgar, Terence S.; Francisco, Gerard E.; Graziani, Virginia; Meythaler, Jay M.; Ridgely, Patrick M.; Sadiq, Saud; Turner, Michael S.

doi:10.1053/apmr.2002.32820

Cited by 248 publications

(172 citation statements)

References 26 publications

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“…13,20 During a drug holiday, hospital admission is mandatory, because of the risk of baclofen withdrawal syndrome. 14 The reported dose reduction after restarting ITB therapy varies significantly, ranging from back to initial postimplantation doses (100-200 mg per day) to even higher doses as compared to the pre-drug-holiday doses. 6 Most patients however needed higher doses of ITB within a month after the drug holiday.…”

Section: Drug Holiday Vs Pulsatile Bolus Infusionmentioning

confidence: 99%

Tolerance to continuous intrathecal baclofen infusion can be reversed by pulsatile bolus infusion

2009

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Study design: Pilot study. Objective: To study the effect of pulsatile bolus infusion of intrathecal baclofen (ITB) on daily ITB dose, in patients showing dose increases, probably due to tolerance. Setting: Department of neurology and neurosurgery, University Medical Center Groningen, the Netherlands. Methods: Data on dosages and clinical efficacy were gathered from four patients who were switched from continuous to pulsatile bolus infusion of ITB, because of the probable diagnosis of tolerance to ITB. Results: Switching from continuous to pulsatile bolus infusion resulted in a decrease of the daily ITB dose, while the clinical effect could be kept stable, without introducing adverse events. Conclusion: Pulsatile bolus infusion of ITB seems to be an effective and safe treatment strategy to reverse the need for increasing ITB dosages in patients with the probable diagnosis of tolerance to ITB.

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Section: Drug Holiday Vs Pulsatile Bolus Infusionmentioning

confidence: 99%

Tolerance to continuous intrathecal baclofen infusion can be reversed by pulsatile bolus infusion

2009

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“…Catheter and pump malfunctions as well as severe overdoses have been reported with notable incidence. 2,[18][19][20][21] …”

Section: Introductionmentioning

confidence: 99%

Treatment of spasticity with intrathecal Baclofen administration: long-term follow-up, review of 40 patients

et al. 2004

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Study design: Case series of a consecutive sample. Retrospective audit. Objective: To analyze the long-term safety and efficacy of intrathecal baclofen (ITB), and technical incidents. Setting: Neurosurgical and Physical Medicine Departments of two university hospitals in western France. Methods: The medical records of 40 patients who underwent ITB pump placement for the treatment of severe chronic spasticity were reviewed. Patients were eligible independently of the origin of the spasticity (spinal cord origin 33, brain damage 8). They underwent a final assessment with clinical examination and questionnaire in 2001. Ashworth scale scores were assessed, patient satisfaction was rated on a visual analog scale (VAS), functional independence before and after treatment was classified as bed-ridden, wheelchair dependant or ambulant, and the frequency and nature of complications were noted. Results: The average follow-up period was of 4 years. The average Ashworth score at the final assessment was 1.870.6. Average patients satisfaction was 7.4/1072.21 on VAS. In all, 85% would have undergone the procedure again if they had to make the decision. In 85% of the cases the ambulation status was unchanged. Technical incidents occured at least once in 37% of the patients (due to the catheter in 58% and to the pump in 42%). They included catheter disconnections (4), migration (4), kinks (3), obstruction (3), development of fibrosis (3), disconnection of pump reservoir (2), porosity of pump membrane (2), unexplained pump dysfunction (4) leakage, and subcutaneous collection (5). Severe pharmacological side effects requiring transfer to intensive care unit occured in 12% of cases, 80% of which were directly related to pump refill procedures. Conclusion: ITB remained effective in the long term and patients were satisfied. Nevertheless, complications were frequent, involving mainly the catheters, which would require further technical improvements.

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“…6 We did not have fatal cases during the episode of baclofen delirium, and the mortality outcome was not different in patients with delirium or without it. This, in spite of studies in different medical contexts, associates delirium with a high mortality.…”

Section: Discussionmentioning

confidence: 70%

“…1,4 Withdrawal is a risk situation associated with the use of baclofen. It exhibits a physical component characterized by pruritus without rash, tachycardia, hypotension, diaphoresis, diplopia, tremor, fever, spasticity, convulsions, hyperthermia and rhabdomyolysis, 5,6 and a psychiatric component with hallucinations, confusion, agitation and delusions. [7][8][9] Symptoms begin 12-72 h after dose reduction or suppression and respond 24-72 h after the restoration of treatment and support measures.…”

Section: Introductionmentioning

confidence: 99%

Delirium secondary to intrathecal baclofen

et al. 2008

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Study design: Retrospective study based on a revision of the clinical histories of all patients carrying an intrathecal baclofen (ITB) infusion system between July 1988 and March 2007 in a neurorehabilitation hospital. Objectives: To describe the psychiatric manifestations due to intoxication or withdrawal of ITB and to explore the possible risk factors for the presentation of delirium secondary to baclofen. Setting: Spinal Cord Injury Unit in Barcelona, Spain. Methods: We selected patients who presented delirium related to baclofen treatment. We filtered these cases by the search of key words. All the compatible episodes were then reviewed and positive cases were confirmed to perform a descriptive analysis of the different variables. Control subjects were randomly selected for a comparative analysis of the aspects of interest. Results: A total of 12 of the 126 patients carrying the intrathecal system in our hospital presented delirium related to baclofen. Eight cases due to intoxication (66.6%) and four due to withdrawal (33.3%) were found. We provide a description of the psychiatric symptoms. There were no fatal cases due to delirium. Conclusion: Delirium has a frequency of 9.5% in patients carrying the ITB infusion system, intoxication being more frequent than withdrawal.

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Abrupt withdrawal from intrathecal baclofen: Recognition and management of a potentially life-threatening syndrome

Cited by 248 publications

References 26 publications

Tolerance to continuous intrathecal baclofen infusion can be reversed by pulsatile bolus infusion

Tolerance to continuous intrathecal baclofen infusion can be reversed by pulsatile bolus infusion

Treatment of spasticity with intrathecal Baclofen administration: long-term follow-up, review of 40 patients

Delirium secondary to intrathecal baclofen

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