Prolonged intrathecal baclofen withdrawal syndrome. Case report and discussion of current therapeutic management.
The authors describe a patient who experienced a prolonged course of intrathecal baclofen withdrawal syndrome after removal of an implantable baclofen pump for treatment of pump infection and meningitis. The current literature outlines management options for the acute management of this syndrome. In this report the authors discuss the long-term presentation of this syndrome and suggest a treatment strategy for management of the syndrome. A 37-year-old man who presented with a baclofen pump infection and meningitis experienced acute onset of intrathecal baclofen withdrawal syndrome 12 hours after the pump had been surgically removed. The patient's symptoms evolved into a severe, treatment-refractory withdrawal syndrome lasting longer than 1 month. Oral baclofen replacement with adjunctive administration of parenteral gamma-aminobutyric acid agonists only served to stabilize the patient's critical condition throughout his hospital course. Replacement of the baclofen pump and restoration of intrathecal delivery of the medication was necessary to trigger the patient's dramatic recovery and complete reversal of the withdrawal syndrome within approximately 48 hours. These findings indicate that a more direct method of treating infected baclofen pumps than immediate surgical removal is necessary to prevent the onset of intrathecal baclofen withdrawal syndrome. Various options for preventing the onset of the syndrome while simultaneously treating the infection are discussed.
Douglas
Andrea F
AF
Department of Neurological Surgery, Division of Pediatric Neurosurgery, New York University Medical Center, New York, New York 10016, USA.
Weiner
Howard L
HL
Schwartz
David R
DR
D000328:Adult; D001418:Baclofen / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D007260:Infusion Pumps / Q000382:microbiology; D007278:Injections, Spinal; D008297:Male; D008581:Meningitis / Q000150:complications / Q000188:drug therapy; D016106:Methicillin Resistance; D009125:Muscle Relaxants, Central / Q000008:administration & dosage* / Q000009:adverse effects*; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D013119:Spinal Cord Injuries / Q000150:complications; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000382:microbiology
D009125:Muscle Relaxants, Central; D001418:Baclofen