title: Status dystonicus and Hallervorden-Spatz disease: treatment with intrathecal baclofen and pallidotomy.
abstract: Severe dystonia or status dystonicus is a life threatening disorder that develops in patients with both primary and secondary dystonia. We present the case of a 9-year-old boy with Hallervorden-Spatz disease (HVS) who developed status dystonicus, failing to respond to high dose oral therapy with multiple antidystonic agents. High dose intravenous sedating agents combined with endotracheal intubation and mechanical ventilation were required to control the spasms. Alleviation of the spasms was achieved by a combination of temporary intrathecal baclofen infusions and bilateral pallidotomy. Although it could be argued this is a situation where only palliative measures should be used, we believe a relatively aggressive approach was justified. It relieved the intense pain associated with the spasms and allowed the child to be discharged home without the prolonged stay in intensive care, morbidity and mortality, which characterize status dystonicus.
authors.affiliation: The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Kyriagis
authors.forename: P
authors.initials: P
authors.lastname: Grattan-Smith
authors.forename: A
authors.initials: A
authors.lastname: Scheinberg
authors.forename: C
authors.initials: C
authors.lastname: Teo
authors.forename: N
authors.initials: N
authors.lastname: Nakaji
authors.forename: M
authors.initials: M
authors.lastname: Waugh
mesh_terms: D001418:Baclofen / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D020821:Dystonic Disorders / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D005917:Globus Pallidus / Q000601:surgery; D006801:Humans; D007278:Injections, Spinal; D008279:Magnetic Resonance Imaging; D008297:Male; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D006211:Pantothenate Kinase-Associated Neurodegeneration / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen