Corrales-Arroyo MJ, López-Gallardo G, Del Real-Francia MÁ

Language: Spanish
References: 17
Page: 175-178
PDF size: 214.62 Kb.

ABSTRACT

Introduction: Intrathecal baclofen (ITB) treatment is increasingly used in cases of severe spasticity. It is very important to know the eventual complications that can appear during the therapy.
Objetive: To emphasize the importance of an early identification of symptoms and differential diagnosis of the intrathecal baclofen withdrawal syndrome (ITBWS), in order to be able to establish opportunely the correct treatment, essential to achieve an optimal outcome.
Case Report: We report our experience with the clinical case of a patient with multiple sclerosis and severe spasticity treated with ITB who presented a fatal ITBWS.
Cnclusiones: The abrupt baclofen intrathecal withdrawal can cause a syndrome with deadly consequences, which justifies the importance of its early identification and distinction from other syndromes with similar symptoms, but with very different treatments.

REFERENCES

1. Coffey RJ, Edgar TS, Francisco GE, Graziani V, Meythaler JM, RIdgely PM, et al. Abrupt withdrawal from intrathecal baclofeno: recognition Figura 1. Radiografía simple de abdomen donde se observa la disposición de la bomba de infusión de baclofeno intratecal.

2. Penn RD, Droin JS. Intrathecal baclofen alleviates spinal cord spasticity. Lancet 1984; 1(8385): 1078.

3. Sanger TD, Deslgado MR, Gaeble-Spira D, Hallett M, Mink JW. Classification and definition of disorders causing hypertonía in childhood. Pediatrics 2003; 111(1): e89-97.

4. Kolaski K, Logan LR. A review of the complications of intrathecal baclofen in patients with cerebral lpalsy. Neuro Rehabil 2007; 22: 383-95.

5. Brennan PM, Whittle IR. Intrathecal cablofeno therapy for neurological disorders: a sound knowledge base but many challenges remain. Br J Neurosurg 2008; 22: 508-19.

6. Dykstra D, Stuckey M, Des Lauriers L, Chappuis D, Krach L. Intrathecal baclofeno in the treatment of spasticity. Acta Neurochir Suppl 2007: 97(Pt 1): 163-7.

7. Penn RD, York MM, Paice JA. Catheter systems for intrathecal drug delivey. J Neurosurg 1995; 83: 215-17.

8. Allerton CA, Boden PR, Hill RG. Actions of the GABAb agonistbaclofen, on neurones in deep dorsal horn of the rat spinal cord in vitro. Br J Pharmacol 1989; 96: 29-38.

9. Peng CT, Ger J, Yang CC, Tsai WJ, Deng JF, Bullard MJ. Prolonged severe withdrawal symptoms after acute on chronic baclofen overdose. J ToxicolClinToxicol 1998; 36: 359-63.

10. Green LB, Nelson VS. Death after acute withdrawal of intrathecal baclofen: case report and literature review. Arch Phys Med Rehabil 199, 80: 1600-4.

11. Khorasani A, Peruzzi WT. Dantrolene treatment for abrupt intrathecal baclofen withdrawal. AnesthAnalg 1995; 80: 1054-6.

12. Meythaler JM, Roper JF, Brunner RC. Cyproheptadine for intrathecal baclofen withdrawal. Arch Phys Med Rehabil 2003; 84: 638-42.

13. Reeves RK, Stolp-Smith KA, Christopherson MW. Hyperthermia, rhabdomyolysis and disseminated intravascular coagulation associated with baclofen pump catheter failure. Arch Phys Med Rehabil 1998; 79: 353-6.

14. Katz RT, Campagnolo DI. Pharmacologic management of spasticity. Physical Medicine and Rehabilitation 1984; 8: 473-80.

15. Dall JT, Harmon RI, Quinn CM. Use of clonidine for treatment of spasticity arising from various forms of brain injuty: a case series. Brain Injury 1996; 10(6): 453-8.

16. Kao LW, Amin Y, Kirk Ma, et al. Intrathecal baclofeno withdrawal mimicking sepsis. J Emerg Med 2003; 24: 423-7.

17. Meinck HM, Tronnier V, Rieke K, Wirtz CR, Flugel D, Schwab S. Intrathecal baclofen treatment for stiff-man syndrome: pump failure may be fatal. Neurology 1994; 44: 2209-10.