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Intrathecal Baclofen in Spinal Spasticity: Frequency and Severity of Withdrawal Syndrome.
Pain Physician 2015 Jul-Aug; 18(4):E633-41PP

Abstract

BACKGROUND

Intrathecal baclofen (ITB) delivered by programmable pump devices represents an important modality for long-term treatment of severe spinal spasticity.

OBJECTIVE

One of the serious adverse events is a withdrawal syndrome after sudden interruption of ITB delivery. In this study, we analyzed the frequency and severity of this complication. Treatment recommendations follow.

STUDY DESIGN

Case study.

SETTING

Academic medical center.

METHODS

A total of 54 ITB pumps were successfully implanted in 39 patients with severe intractable spasticity (24 with spinal cord injury, 15 with multiple sclerosis, 24 men, age range 21-59 years).

RESULTS

Eight patients developed a withdrawal syndrome on total a daily dose of ITB between 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 withdrawal syndrome occurred once in 20.1 pump-years counted out of 160.4 pump-years of ITB treatment.

LIMITATIONS

Small sample size.

CONCLUSIONS

ITB withdrawal syndrome is a rare but life-threatening event and prompt diagnosis before treatment initiation is critical. The reported events were mostly mild due to the acute treatment regime and probably due to a lower dose of ITB. A prerequisite for successful ITB treatment is a deep knowledge of complications and their prompt management in the hands of a multidisciplinary team in specialized centers.

Authors+Show Affiliations

Department of Neurology, Third School of Medicine, Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic; Department of Neurosurgery, Third School of Medicine, Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26218954

Citation

Stetkarova, Ivana, et al. "Intrathecal Baclofen in Spinal Spasticity: Frequency and Severity of Withdrawal Syndrome." Pain Physician, vol. 18, no. 4, 2015, pp. E633-41.
Stetkarova I, Brabec K, Vasko P, et al. Intrathecal Baclofen in Spinal Spasticity: Frequency and Severity of Withdrawal Syndrome. Pain Physician. 2015;18(4):E633-41.
Stetkarova, I., Brabec, K., Vasko, P., & Mencl, L. (2015). Intrathecal Baclofen in Spinal Spasticity: Frequency and Severity of Withdrawal Syndrome. Pain Physician, 18(4), pp. E633-41.
Stetkarova I, et al. Intrathecal Baclofen in Spinal Spasticity: Frequency and Severity of Withdrawal Syndrome. Pain Physician. 2015;18(4):E633-41. PubMed PMID: 26218954.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intrathecal Baclofen in Spinal Spasticity: Frequency and Severity of Withdrawal Syndrome. AU - Stetkarova,Ivana, AU - Brabec,Karel, AU - Vasko,Peter, AU - Mencl,Libor, PY - 2015/7/29/entrez PY - 2015/7/29/pubmed PY - 2016/2/26/medline SP - E633 EP - 41 JF - Pain physician JO - Pain Physician VL - 18 IS - 4 N2 - BACKGROUND: Intrathecal baclofen (ITB) delivered by programmable pump devices represents an important modality for long-term treatment of severe spinal spasticity. OBJECTIVE: One of the serious adverse events is a withdrawal syndrome after sudden interruption of ITB delivery. In this study, we analyzed the frequency and severity of this complication. Treatment recommendations follow. STUDY DESIGN: Case study. SETTING: Academic medical center. METHODS: A total of 54 ITB pumps were successfully implanted in 39 patients with severe intractable spasticity (24 with spinal cord injury, 15 with multiple sclerosis, 24 men, age range 21-59 years). RESULTS: Eight patients developed a withdrawal syndrome on total a daily dose of ITB between 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 withdrawal syndrome occurred once in 20.1 pump-years counted out of 160.4 pump-years of ITB treatment. LIMITATIONS: Small sample size. CONCLUSIONS: ITB withdrawal syndrome is a rare but life-threatening event and prompt diagnosis before treatment initiation is critical. The reported events were mostly mild due to the acute treatment regime and probably due to a lower dose of ITB. A prerequisite for successful ITB treatment is a deep knowledge of complications and their prompt management in the hands of a multidisciplinary team in specialized centers. SN - 2150-1149 UR - https://www.unboundmedicine.com/medline/citation/26218954/Intrathecal_Baclofen_in_Spinal_Spasticity:_Frequency_and_Severity_of_Withdrawal_Syndrome_ L2 - http://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=18&page=E633 DB - PRIME DP - Unbound Medicine ER -