Abstract
Background
Intrathecal Baclofen (ITB) has become an increasingly common treatment for severe
muscle spasticity associated with conditions such as cerebral palsy and spinal cord
injury. Classically, withdrawal symptoms mimic symptoms of serotonin syndrome with
hypertension, increased spasticity, clonus, hyperthermia, tachycardia, and possibly
acute psychosis. Hypotension, muscle flaccidity, and respiratory depression are generally
considered symptoms of toxicity or overdose.
Case Report
We present the case of a male with recent ITB pump revision who presented with autonomic
features suggestive of Baclofen withdrawal, while the remainder of his physical examination
suggested appropriate medication dosing. Interrogation of the patient's ITB pump revealed
normal function, and the patient had no clinical change with intravenous benzodiazepines,
but his condition ultimately improved when his Baclofen dosing was decreased, indicating
toxicity instead of withdrawal.
Why Should an Emergency Physician Be Aware of This?
As Baclofen pump use increases, the importance of recognizing these potentially life-threatening
complications also increases. This case presents the emergency physician with an atypical
presentation and emphasizes the importance of a thorough neurologic examination to
diagnose patients accurately.
Keywords
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References
- Intrathecal baclofen therapy-practical approach: clinical benefits and complication management.J Child Neurol. 2018; 33: 734-741
- Management baclofen withdrawal syndrome.Rev Col Anest. 2012; 40: 158-161
- Intrathecal Baclofen for intractable spasticity of spinal origin: results of a long-term multicenter study.J Neurosurg. 1993; 78: 226-232
- Withdrawal syndromes.Emerg Med Clin North Am. 2000; 18: 273-288
- Intrathecal Baclofen withdrawal resembling serotonin syndrome in an adolescent boy with cerebral palsy.Pediatr Emerg Care. 2008; 24: 691-693
- Intrathecal Baclofen overdose and withdrawal.Pediatr Emerg Care. 2006; 22: 258-261
- Complications of Baclofen withdrawal.Arch Neurol. 1981; 38: 588-589
- Management of acute overdose or withdrawal state in intrathecal Baclofen therapy.Spinal Cord. 2012; 50: 107-111
- Baclofen overdose: defining the spectrum of toxicity.Emerg Med Australas. 2006; 18: 77-82
- Abrupt withdrawal from intrathecal Baclofen: recognition and management of a potentially life-threatening syndrome.Arch Phys Med Rehabil. 2002; 83: 735-741
- Intrathecal Baclofen withdrawal mimicking sepsis.J Emerg Med. 2003; 24: 423-427
- Cyproheptadine for intrathecal Baclofen withdrawal.Arch Phys Med Rehabil. 2003; 84: 638-642
Article info
Publication history
Published online: March 20, 2020
Accepted:
December 22,
2019
Received in revised form:
December 22,
2019
Received:
September 11,
2019
Footnotes
Reprints are not available from the authors.
Identification
Copyright
Published by Elsevier Inc.
