Intrathecal baclofen withdrawal: a case report and review of the literature.
BACKGROUND
Spasticity is an endpoint of a variety of neurologic disorders with upper motor neuron damage. There have been several studies demonstrating improvement in spasticity through administration of intrathecal baclofen. Withdrawal from oral baclofen has been well described. Intrathecal baclofen withdrawal has been less frequently reported. We present a case of withdrawal after intrathecal baclofen pump catheter failure.


METHODS
A 14-year-old boy presented with fevers, which were thought to be related to recent spine surgery and possible pneumonia. Eventual workup revealed evidence of intrathecal baclofen withdrawal owing to pump catheter failure. His fevers, with temperatures of up to 40 degrees C, and painful muscle spasms resolved and his clinical condition improved after pump exploration and resumption of intrathecal delivery.


CONCLUSIONS
Intrathecal baclofen withdrawal can be life threatening. Prompt recognition and restoration of an adequate intrathecal baclofen dose is essential for recovery.
Alden
Tord D
TD
Department of Neurosurgery, St. Louis Children's Hospital, One Children's Place, Suite 4S20, Washington University School of Medicine, MO 63110, USA.
Lytle
Richard A
RA
Park
T S
TS
Noetzel
Michael J
MJ
Ojemann
Jeffrey G
JG
D000293:Adolescent; D000326:Adrenoleukodystrophy / Q000188:drug therapy*; D001418:Baclofen / Q000008:administration & dosage / Q000009:adverse effects*; D004868:Equipment Failure; D005334:Fever / Q000139:chemically induced*; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000009:adverse effects*; D009128:Muscle Spasticity / Q000188:drug therapy; D013375:Substance Withdrawal Syndrome / Q000209:etiology*
D009125:Muscle Relaxants, Central; D001418:Baclofen