Paralytic ileus: a complication after intrathecal baclofen therapy.
BACKGROUND
Baclofen is frequently used in the management of spasticity. When the therapeutic benefit of oral baclofen is not satisfactory, intrathecal administration should be considered. This method reduces side effects due to a reduction in dosage compared to oral administration.


METHODS
This study presents a 52-year-old man with tetraplegia after a brainstem stroke. Four days after the placement of a Synchromed II infusion pump (100 mcg per day), the patient presented a paralytic ileus. The treatment was conservative and the dosage of intrathecal baclofen was reduced to lowest drug flow. After 15 days of treatment the ileus was resolved and the dosage progressively increased without incident.


CONCLUSIONS
Ileus should be considered as a rare side effect after intrathecal baclofen administration, especially in cases of brainstem injury because baclofen seems to act directly over vegetative brainstem nuclei. Based on this case, it is strongly recommended to decrease the dose of intrathecal baclofen as one of the main therapeutic options.
Morant
Amparo
A
Servicio de Daño Cerebral, Hospitales Nisa, Instituto Valenciano de Neurorrehabilitación, Valencia, Spain.
Noé
Enrique
E
Boyer
José
J
Escamilla
Benigno
B
Trénor
Carlos
C
Ferri
Joan
J
Chirivella
Javier
J
D001418:Baclofen / Q000009:adverse effects*; D020526:Brain Stem Infarctions / Q000150:complications; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000009:adverse effects*; D009128:Muscle Spasticity / Q000188:drug therapy / Q000209:etiology
D009125:Muscle Relaxants, Central; D001418:Baclofen