Intrathecal baclofen toxicity

Stroud, Jason M; Scattoloni, Joseph A.; Blasingim, Melanie; Nafiu, Olubukola O.

doi:10.1097/eja.0000000000000055

Cited by 6 publications

(2 citation statements)

References 7 publications

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“…Muscular weakness has also been reported in patients on oral baclofen for spasticity [16,17]. Baclofen impacts control of ventilation and can cause central apnea events [18], with overdose reported to cause flaccid paralysis and respiratory depression [19,20].…”

Section: Discussionmentioning

confidence: 99%

Respiratory dysfunction following initiation of mirabegron: A case report

Malsin

Coleman

Wolfe

et al. 2019

Respiratory Medicine Case Reports

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Background: Mirabegron, a β3 adrenergic receptor agonist, is FDA approved for treatment of overactive bladder. Approved in 2012 in the US, there have been no reports of any effects of mirabegron on pulmonary function. Case presentation: We report the case of a 65 year old male with a history of Parkinson's disease, OSA, and aspiration pneumonia presenting with subacute worsening dyspnea and found to have worsening restrictive ventilatory defect with a pattern consistent with neuromuscular weakness. After recalling that initiation of mirabegron correlated with onset of his worsening symptoms, the patient decided to perform a trial period off the drug. He subsequently reported prompt improvement in his respiratory symptoms, which was confirmed objectively by pulmonary function tests. In this case, mirabegron was temporally associated with subacute worsening of the patient's pulmonary restrictive physiology, with subsequent resolution after discontinuation of the medication. Conclusions: The mechanism of this adverse effect is unknown, but we speculate that this effect may be potentially mediated by the effect of β3 adrenergic receptor agonism on skeletal muscle, in this case in a patient with pre-existing neuromuscular disease. Careful assessment of patients who develop shortness of breath while on mirabegron should include an assessment for restrictive lung disease secondary neuromuscular dysfunction. Additional study is needed of the effects of β3 agonism on skeletal muscle.

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Section: Discussionmentioning

confidence: 99%

Respiratory dysfunction following initiation of mirabegron: A case report

Malsin

Coleman

Wolfe

et al. 2019

Respiratory Medicine Case Reports

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“…2 Baclofen overdose mimicking brainstem death has been reported rarely in the literature to date. [3][4][5][6][7][8] Intrathecal baclofen overdoses in general can be due to pump malfunction, catheter malfunction and incorrect programming. The resultant effects include flaccid paralysis, bradycardia, hypotension, respiratory depression and central nervous system depression, but rarely do they mimic brainstem death following an unrelated surgical procedure.…”

Section: Nicorette 25mg Om 25mgmentioning

confidence: 99%

Intrathecal baclofen overdose mimicking brainstem death during deep brain stimulation surgery for pain

Alamri

Mostofi

Aziz

et al. 2022

annals

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We describe a unique case of intrathecal baclofen overdose mimicking brainstem death, during bilateral anterior cingulate cortex deep brain stimulation (DBS) for pain. A 37-year-old man with chronic regional pain syndrome requiring an intrathecal baclofen pump underwent DBS under general anaesthesia and experienced an intraoperative generalised tonic–clonic seizure on dural opening. Once the operation was completed, the patient was noted to have fixed, dilated pupils bilaterally and was transferred for an emergency computed tomography scan of the head, which did not reveal any acute intracranial pathology. The patient was transferred to the intensive care unit for management of concurrent hypotension, bradycardia and supportive management of his low Glasgow Coma Scale (GCS) score. A trial of atropine to counter the bradycardia was unsuccessful. Intrathecal baclofen toxicity was suspected as a diagnosis of exclusion, necessitating urgent aspiration of the baclofen pump. The patient’s GCS score improved after pump aspiration and he was discharged home several days later. It was noted that the intrathecal baclofen pump had been refilled several days previously and the patient had reported intermittent episodes of somnolence. In perioperative patients with intrathecal baclofen pumps in situ, baclofen toxicity should always be considered as a differential in perioperative complications, even if it is considered a rare event.

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