title: An unusual cause of flaccid paralysis and coma: baclofen overdose.
abstract: Baclofen is a γ-aminobutyric acid (GABA) agonist that is commonly prescribed for the treatment of spasticity in children. The clinical indications for baclofen use in the pediatric population have increased in recent years. Prescribing baclofen mandates education regarding abrupt withdrawal and overdose because of the severe clinical reactions this can precipitate. This report highlights the case of a patient who presented with acute onset of coma and a flaccid paralysis after baclofen overdose. We reviewed the presentation, clinical course, diagnostic studies, and outcome of this patient. A review of prior literature regarding baclofen overdose is included. Baclofen overdose is heralded by dose-related alteration in consciousness and weakness, progressing to coma and a flaccid paralysis. Screening for baclofen overdose is accomplished through high-power liquid chromatography. Baclofen overdose is treated with supportive care and antiepileptic medications as indicated. There is usually full spontaneous recovery with elimination of the medication.
authors.affiliation: 1Pediatric Neurology, The University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Neuroscience Institute, Memphis, TN, USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Caron
authors.forename: Robin
authors.initials: R
authors.lastname: Morgan
authors.forename: James W
authors.initials: JW
authors.lastname: Wheless
mesh_terms: D000293:Adolescent; D001418:Baclofen / Q000009:adverse effects*; D002490:Central Nervous System / Q000473:pathology; D003128:Coma / Q000139:chemically induced*; D062787:Drug Overdose / Q000150:complications / Q000209:etiology*; D004829:Epilepsy, Generalized / Q000188:drug therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009125:Muscle Relaxants, Central / Q000009:adverse effects*; D011782:Quadriplegia / Q000139:chemically induced*
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen
keywords: burst suppression; toxicity