title: Management of acute overdose or withdrawal state in intrathecal baclofen therapy.
abstract: METHODS
  Individuals who are treated with intrathecal Baclofen (ITB) pump delivery system for intractable spasticity can suffer from severe morbidity as a result of acute overdose or withdrawal of ITB, which can also be life threatening. Current literature has a number of single case studies with different approaches to the management in such states.
  
  
  OBJECTIVE
  The aim of this article is to consolidate available evidence and develop treatment pathways for acute ITB overdose and withdrawal states.
  
  
  METHODS
  We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library databases using the keywords 'intrathecal', 'baclofen', 'withdrawal', 'overdose' to identify studies (published up to December 2010) that focused on presentation or treatment of acute overdose and withdrawal state in ITB therapy. Only original articles in English involving adult population were included.
  
  
  RESULTS
  Initial search revealed 130 articles. After reading the abstract, 13 studies on ITB overdose and 23 studies on ITB withdrawal were deemed suitable for inclusion. All studies were either single-case studies or case series.
  
  
  CONCLUSIONS
  Acute ITB overdose is managed with immediate cessation of baclofen delivery through the system, reducing the baclofen load by cerebrospinal fluid aspiration and by providing supportive treatment in an intensive care setting. There is no specific antidote for reversing overdose symptoms. Acute ITB withdrawal is managed by restoring the delivery of ITB, providing supportive care in an intensive care setting and using drugs like low dose propofol or benzodiazepines in selected cases. Early involvement of ITB physicians is strongly recommended.
authors: Yorkshire Regional Spinal Injuries Unit, Pinderfield Hospital, Wakefield, UK.
authors: S V
authors: SV
authors: Watve
authors: M
authors: M
authors: Sivan
authors: W A
authors: WA
authors: Raza
authors: F F
authors: FF
authors: Jamil
mesh_terms: D000328:Adult; D001418:Baclofen / Q000008:administration & dosage / Q000506:poisoning* / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D062787:Drug Overdose / Q000628:therapy*; D006801:Humans; D015918:Infusion Pumps, Implantable; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D001569:Benzodiazepines; D001418:Baclofen