Management of acute overdose or withdrawal state in intrathecal baclofen therapy

Abstract

Study design: Individuals who are treated with intrathecal Baclofen (ITB) pump delivery system for intractable spasticity can suffer from severe morbidity as a result of acute overdose or withdrawal of ITB, which can also be life threatening. Current literature has a number of single case studies with different approaches to the management in such states. Objectives: The aim of this article is to consolidate available evidence and develop treatment pathways for acute ITB overdose and withdrawal states. Methods: We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library databases using the keywords 'intrathecal', 'baclofen', 'withdrawal', 'overdose' to identify studies (published up to December 2010) that focused on presentation or treatment of acute overdose and withdrawal state in ITB therapy. Only original articles in English involving adult population were included. Results: Initial search revealed 130 articles. After reading the abstract, 13 studies on ITB overdose and 23 studies on ITB withdrawal were deemed suitable for inclusion. All studies were either single-case studies or case series. Conclusion: Acute ITB overdose is managed with immediate cessation of baclofen delivery through the system, reducing the baclofen load by cerebrospinal fluid aspiration and by providing supportive treatment in an intensive care setting. There is no specific antidote for reversing overdose symptoms. Acute ITB withdrawal is managed by restoring the delivery of ITB, providing supportive care in an intensive care setting and using drugs like low dose propofol or benzodiazepines in selected cases. Early involvement of ITB physicians is strongly recommended.

Baclofen pump catheter leakage after migration of the abdominal catheter in a pediatric patient with spasticity

“…3,10,14,20,21,25,32,47 Baclofen withdrawal symptoms can begin within the first 3 days after slowing or stopping the medication, whether orally or intrathecally. 10,29,38,39,46,47 These symptoms are likely caused by the removal of the inhibitory tone on the GABA B receptors. 10,38,46 Catheter-related complications are the most common type of complication associated with intrathecal baclofen pumps.…”

“…3,6,10,11,14,[19][20][21][22]25,31,32,37,40,47 Watve et al observed that intrathecal baclofen withdrawal is frequently due to catheter malfunction. 46 Baclofen withdrawal can be characterized by reflex spasticity, seizures, central nervous system depression, and hyperthermia, which may progress to disseminated intravascular coagulation and organ failure if left untreated. 3,10,14,20,21,25,32,47 Baclofen withdrawal symptoms can begin within the first 3 days after slowing or stopping the medication, whether orally or intrathecally.…”

Correlation between the single, high dose of ingested baclofen and clinical symptoms

“…In the opinion of the authors of the current study, however, acute psychosis after baclofen poisoning does not depend on its dose, and it is rather a 'withdrawal' symptom. Therefore, chronic baclofen therapy, for example, should not be discontinued abruptly, as rapid cessation may lead to development of severe withdrawal symptoms [1,17,18]. Treatment of baclofen intoxication is mainly supportive.…”

Baclofen overdose from possible intrinsic malfunction of SynchroMed II pump

“…Most commonly, the complications are the result of a problem with the catheter. 1,3,[9][10][11] Intrinsic pump malfunction appears to be a rare complication; there is only 1 reported case in the current literature. 10 In this paper, we present the case of a 10-year-old boy who progressed to acute baclofen overdose on 2 separate occasions after baclofen pump refill by 2 different individuals.…”