Baclofen overdose from possible intrinsic malfunction of SynchroMed II pump

Davanzo, Justin R.; Rizk, Elias

doi:10.3171/2015.1.peds14500

Cited by 6 publications

(3 citation statements)

References 10 publications

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“…A chronic drug supply can be provided by implanted medical devices. Although, such techniques are in clinical use, these routes of administration are invasive and their use is predominantly limited to intensive care as the risk of infections is not neglectable [ 5 , 6 , 7 , 8 , 9 ]. Hence, a safe and efficient drug delivery platform technology for CNS active molecules is needed.…”

Section: Cns Drug Deliverymentioning

confidence: 99%

Tailoring Formulations for Intranasal Nose-to-Brain Delivery: A Review on Architecture, Physico-Chemical Characteristics and Mucociliary Clearance of the Nasal Olfactory Mucosa

2018

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The blood-brain barrier and the blood-cerebrospinal fluid barrier are major obstacles in central nervous system (CNS) drug delivery, since they block most molecules from entering the brain. Alternative drug delivery routes like intraparenchymal or intrathecal are invasive methods with a remaining risk of infections. In contrast, nose-to-brain delivery is a minimally invasive drug administration pathway, which bypasses the blood-brain barrier as the drug is directed from the nasal cavity to the brain. In particular, the skull base located at the roof of the nasal cavity is in close vicinity to the CNS. This area is covered with olfactory mucosa. To design and tailor suitable formulations for nose-to-brain drug delivery, the architecture, structure and physico-chemical characteristics of the mucosa are important criteria. Hence, here we review the state-of-the-art knowledge about the characteristics of the nasal and, in particular, the olfactory mucosa needed for a rational design of intranasal formulations and dosage forms. Also, the information is suitable for the development of systemic or local intranasal drug delivery as well as for intranasal vaccinations.

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Section: Cns Drug Deliverymentioning

confidence: 99%

Tailoring Formulations for Intranasal Nose-to-Brain Delivery: A Review on Architecture, Physico-Chemical Characteristics and Mucociliary Clearance of the Nasal Olfactory Mucosa

2018

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“…Although these methods are used in clinical applications, they are associated with drawbacks such as invasiveness, low central bioavailability, and requiring clinical supervision during administration [2,3].…”

Section: Introductionmentioning

confidence: 99%

Enhanced nose-to-brain delivery of tranilast using liquid crystal formulations

See

Arce

Dahlizar

et al. 2020

Journal of Controlled Release

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Highlights• Intranasal delivery of tranilast was enhanced by MGE and GMO liquid crystals • Biodistribution of administered LC formulations was visualized by micro-computed tomography tandem in vivo imaging systems • MGE and GMO formed liquid crystal structures with formulation characteristics supporting brain uptake of lipophilic drugs ABSTRACT Intranasal administration is poised as a competent method in delivering drugs to the brain, because the nasal route has a direct link with the central nervous system bypassing the formidable blood-brain barrier. C17-monoglycerol ester (MGE) and glyceryl monooleate (GMO) as liquid crystal (LC)-forming lipids possess desirable formulation characteristics as drug carriers for intranasally administered drugs. This study investigated the effect of LC formulations on the pharmacokinetics of tranilast (TL), a lipophilic model drug, and its distribution in the therapeutic target regions of the brain in rats. The anatomical biodistribution of LC formulations was monitored using micro-computed tomography tandem in vivo imaging systems. MGE and GMO effectively formed LC with suitable particle size, zeta potential, and viscosity supporting the delivery of TL to the brain. MGE and GMO LC formulations enhanced brain uptake by 10-to 12-fold and 2-to 2.4-fold, respectively, compared with TL solution.The olfactory bulb had the highest TL concentration and fluorescent signals among all the brain regions, indicating a direct nose-to-brain delivery pathway of LC formulations. LC-forming lipids, MGE and GMO, are potential biomaterials in formulations intended for intranasal administration.

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“…Pump malfunctioning is common mostly by catheter problems, as CSF leakage, infection, catheter kink, obstruction, disconnection, dislodgment, breaking and others. Pump intrinsic malfunction is rare [2,3]. Since September 2011 Medtronic developed a new catheter, Ascenda®, whichreduces distal complications, as well as major complications in general [4].…”

Section: Introductionmentioning

confidence: 99%

Baclofen Pump Pseudo-Malfunctioning: Refractory Spasticity Associated to Cholecystitis

Mônaco¹

2017

OAJNN

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There are several unleashing factors associated with spasticity worsening such as infection, pain, immobility, emotional factors, and others. Baclofen pumpis a standard treatment for selected severe spasticity cases. The authors report a case of a suspected baclofen pump malfunctioning in a paraplegic spastic patient secondary to spinal cord injury. Patient became refractory to intrathecal baclofen therapy (ITB), despite raising levels, in a complex flex mode infusion using Medtronic Infusion Pump Synchromed 2®. Image investigation and catheter patency tests were performed, without obstruction. Patient became from Modified Ashwoth Scale (MAS) 0 to 4 in different times during a day. The same occurred with Penn Spams Scale. Patient was diagnosed with cholecystitis andunderwent tolaparoscopic surgery. After gallbladder resection, patient became MAS 0 and Penn 0. Spasticity patients using ITB that become refractory to treatment should be evaluated for common unleashing factor, including cholecystitis, before suspecting of pump malfunctioning.

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Baclofen overdose from possible intrinsic malfunction of SynchroMed II pump

Abstract: This is a case report illustrating an overdose of baclofen in a 10-year-old boy due to a likely malfunction of a SynchroMed II pump. This ultimately necessitated a pump replacement. One-year follow-up showed no further incidents of baclofen overdose, with multiple pump refills.

Cited by 6 publications

References 10 publications

Tailoring Formulations for Intranasal Nose-to-Brain Delivery: A Review on Architecture, Physico-Chemical Characteristics and Mucociliary Clearance of the Nasal Olfactory Mucosa

Tailoring Formulations for Intranasal Nose-to-Brain Delivery: A Review on Architecture, Physico-Chemical Characteristics and Mucociliary Clearance of the Nasal Olfactory Mucosa

Enhanced nose-to-brain delivery of tranilast using liquid crystal formulations

Baclofen Pump Pseudo-Malfunctioning: Refractory Spasticity Associated to Cholecystitis

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