Open AccessIntrathecal Baclofen in Spinal Spasticity: Frequency and Severity of Withdrawal Syndrome
Author(s) -
Ivana Štětkářová
Publication year - 2015
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2015/18/e
Subject(s) - medicine , spasticity , baclofen , anesthesia , complication , adverse effect , spinal cord , spinal cord injury , surgery , receptor , psychiatry , agonist
Background: Intrathecal baclofen (ITB) delivered by programmable pump devices representsan important modality for long-term treatment of severe spinal spasticity.Objective: One of the serious adverse events is a withdrawal syndrome after suddeninterruption of ITB delivery. In this study, we analyzed the frequency and severity of thiscomplication. Treatment recommendations follow.Study Design: Case studySetting: Academic medical center.Methods: A total of 54 ITB pumps were successfully implanted in 39 patients with severeintractable spasticity (24 with spinal cord injury, 15 with multiple sclerosis, 24 men, age range21 – 59 years).Results: Eight patients developed a withdrawal syndrome on total a daily dose of ITBbetween 90 – 420 µg/day. Seven patients had catheter-related complications. In one patient,pump failure was observed due to its corrosion. Within the group, baclofen withdrawalsyndrome occurred once in 20.1 pump-years counted out of 160.4 pump-years of ITBtreatment.Limitations: Small sample size.Conclusions: ITB withdrawal syndrome is a rare but life-threatening event and promptdiagnosis before treatment initiation is critical. The reported events were mostly mild dueto the acute treatment regime and probably due to a lower dose of ITB. A prerequisite forsuccessful ITB treatment is a deep knowledge of complications and their prompt managementin the hands of a multidisciplinary team in specialized centers.Key words: Spasticity, intrathecal baclofen, pump systems, complications, withdrawalsyndrome