title: Accidental intoxication with 60 mg intrathecal baclofen: survived.
abstract: BACKGROUND
  Intrathecal baclofen (ITB) is an effective and well-tolerated treatment for patients with severe spasticity. Intoxications are rare and usually iatrogenic, with reported intrathecal boluses varying between 0.050 and 30 mg.
  
  
  METHODS
  We here report the case of a 47-year-old woman with severe spastic paraplegia due to multiple sclerosis who, during a routine filling procedure, accidentally received a bolus of 60 mg ITB because of injection into the side-port instead of the reservoir of her ITB pump (Archimedes(®), Codman, Germany).
  
  
  RESULTS
  After a short period of dizziness, she lost consciousness and stopped breathing. She was immediately intubated, mechanically ventilated, and admitted to the intensive care unit. As specific treatment, she received cerebrospinal fluid drainage through a newly implanted lumbar catheter. A series of generalized and complex partial seizures were treated with levetiracetam and lacosamide. Acute autonomic dysfunction with episodic arterial hypo- and hypertensions was controlled by catecholamines and clonidine, respectively. Recurrent hyperthermia, however, responded neither to drugs nor to physical treatment. After 3 weeks, the patient was discharged without any relevant new neurologic signs or symptoms.
  
  
  CONCLUSIONS
  This case demonstrates that even excessive doses of ITB can let the patients survive without sequelae if treated promptly and offensively. A pertinent problem during detoxification is the question of when to restart ITB to avoid drug withdrawal.
authors.affiliation: Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. benjamin.berger@med.uni-heidelberg.de
authors.forename: Benjamin
authors.initials: B
authors.lastname: Berger
authors.forename: Barbara
authors.initials: B
authors.lastname: Vienenkoetter
authors.forename: Mirjam
authors.initials: M
authors.lastname: Korporal
authors.forename: Andrea
authors.initials: A
authors.lastname: Rocco
authors.forename: Hans-Michael
authors.initials: HM
authors.lastname: Meinck
authors.forename: Thorsten
authors.initials: T
authors.lastname: Steiner
mesh_terms: D001418:Baclofen / Q000008:administration & dosage / Q000506:poisoning*; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007278:Injections, Spinal; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000506:poisoning*; D010264:Paraplegia / Q000188:drug therapy* / Q000209:etiology; D013375:Substance Withdrawal Syndrome / Q000628:therapy
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen