title: A case of delirium, motor disturbances, and autonomic dysfunction due to baclofen and tizanidine withdrawal: a review of the literature.
abstract: We report a case of delirium accompanied by extrapyramidal symptoms and autonomic dysfunction in a 59-year-old man following abrupt cessation of baclofen and tizanidine. An extensive search for the etiology was undertaken, but it was only after a careful history was taken that suspicion for baclofen and tizanidine withdrawal was raised. The delirium and motor disturbances resolved within 24 h of reintroduction of baclofen. Withdrawal from muscle relaxants requires a high index of suspicion but should be considered in patients who manifest signs and symptoms of withdrawal from the medications, particularly visual hallucinations, rigidity and autonomic dysfunction.
authors.affiliation: Duke University Medical Center, Durham, NC 27705, USA. david.karol@duke.edu
authors.forename: David E
authors.initials: DE
authors.lastname: Karol
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Muzyk
authors.forename: Xavier A
authors.initials: XA
authors.lastname: Preud'homme
mesh_terms: D017109:Akathisia, Drug-Induced / Q000209:etiology*; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects*; D001342:Autonomic Nervous System Diseases / Q000139:chemically induced*; D001418:Baclofen / Q000008:administration & dosage / Q000009:adverse effects*; D003000:Clonidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D003693:Delirium / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013375:Substance Withdrawal Syndrome / Q000209:etiology
chemical_list: D000927:Anticonvulsants; C023754:tizanidine; D001418:Baclofen; D003000:Clonidine