scholarly journals Baclofen therapeutics, toxicity, and withdrawal: A narrative review

2021 ◽  
Vol 9 ◽  
pp. 205031212110221
Author(s):  
Jia W Romito ◽  
Emily R Turner ◽  
John A Rosener ◽  
Landon Coldiron ◽  
Ashutosh Udipi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Withdrawal Syndrome ◽  
Alcohol Use Disorder ◽  
Spinal Cord Injuries ◽  
Intrathecal Baclofen ◽  
Narrative Review ◽  
Routes Of Administration ◽  
Baclofen Withdrawal ◽  
Life Threatening ◽  
High Index Of Suspicion

Baclofen is an effective therapeutic for the treatment of spasticity related to multiple sclerosis, spinal cord injuries, and other spinal cord pathologies. It has been increasingly used off-label for the management of several disorders, including musculoskeletal pain, gastroesophageal reflux disease, and alcohol use disorder. Baclofen therapy is associated with potential complications, including life-threatening toxicity and withdrawal syndrome. These disorders require prompt recognition and a high index of suspicion. While these complications can develop following administration of either oral or intrathecal baclofen, the risk is greater with the intrathecal route. The management of baclofen toxicity is largely supportive while baclofen withdrawal syndrome is most effectively treated with re-initiation or supplementation of baclofen dosing. Administration of other pharmacologic adjuncts may be required to effectively treat associated withdrawal symptoms. This narrative review provides an overview of the historical and emerging uses of baclofen, offers practical dosing recommendations for both oral and intrathecal routes of administration, and reviews the diagnosis and management of both baclofen toxicity and withdrawal.

scholarly journals The Intrathecal Baclofen Withdrawal Syndrome: A Systematic Review

2010 ◽  
Vol 8 (7) ◽  
pp. 537
Author(s):  
W.R. Muirhead ◽  
N. Baylem ◽  
I. Jalloh ◽  
M. Vloeberghs
Keyword(s):  
Systematic Review ◽  
Withdrawal Syndrome ◽  
Intrathecal Baclofen ◽  
Baclofen Withdrawal

TENS attenuates response to colon distension in paraplegic and quadriplegic rats

2002 ◽  
Vol 283 (4) ◽  
pp. H1734-H1739 ◽  
Author(s):  
Heidi L. Collins ◽  
Stephen E. DiCarlo
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Cervical Vertebra ◽  
Autonomic Dysreflexia ◽  
Thoracic Vertebrae ◽  
Hemodynamic Responses ◽  
Electrical Nerve Stimulation ◽  
Thoracic Level ◽  
Colon Distension ◽  
Life Threatening

Individuals with spinal cord injuries above thoracic level 6 experience episodic bouts of life-threatening hypertension as part of a condition termed autonomic dysreflexia (AD). The hypertension can be caused by stimulation of the skin, distension of the urinary bladder or colon, and/or muscle spasms. Transcutaneous electrical nerve stimulation (TENS) may reduce the severity of AD because TENS has been used to inhibit second-order neurons in the dorsal horn. Therefore, we tested the hypothesis that TENS attenuates the hemodynamic responses to colon distension. Eleven Wistar rats underwent spinal cord transection between thoracic vertebrae 4 and 5 (paraplegic, n = 6) or between cervical vertebra 7 and thoracic vertebra 1 (quadriplegic, n = 5). After recovery, all rats were instrumented with a radiotelemetry device for recording arterial pressure. Subsequently, the hemodynamic responses to graded colon distension were determined before and during TENS. During TENS the hemodynamic responses to colon distension were significantly attenuated. Thus TENS may be a preventive approach to reduce the severity of AD in paraplegic and quadriplegic individuals.

Prevention of Intrathecal Baclofen Withdrawal Syndrome

2009 ◽  
Vol 34 (6) ◽  
pp. 600-602 ◽  
Author(s):  
Anke Bellinger ◽  
Rapipen Siriwetchadarak ◽  
Richard Rosenquist ◽  
Jeremy D.W. Greenlee
Keyword(s):  
Withdrawal Syndrome ◽  
Intrathecal Baclofen ◽  
Baclofen Withdrawal

scholarly journals Successful non-surgical management of pleuroparenchymal fistula following cervical intraspinal empyema

2018 ◽  
Vol 88 (1) ◽  
Author(s):  
Christopher Ull ◽  
Mirko Aach ◽  
Josef Reichert ◽  
Thomas Armin Schildhauer ◽  
Justyna Swol
Keyword(s):  
Spinal Cord ◽  
Surgical Management ◽  
Spinal Cord Injuries ◽  
Lung Ventilation ◽  
Double Lumen Tube ◽  
Pulmonary Infections ◽  
Talc Pleurodesis ◽  
Lumen Tube ◽  
Cord Injury ◽  
Life Threatening

Pulmonary infections are life-threatening complications in patients with spinal cord injuries. In particular, paraplegic patients are at risk if they are ventilator-dependent. This case history refers to a spinal cord injury with a complete sensorimotor tetraplegia below C2 caused by a septic scattering of an intraspinal empyema at C2-C5 and T3-T4. A right-sided purulent pneumonia led to a complex lung infection with the formation of a pleuroparenchymal fistula. The manuscript describes successful, considerate, non-surgical management with shortterm separate lung ventilation. Treatment aimed to achieve the best possible result without additional harm. A variety of surgical and conservative strategies for the treatment of pleuroparenchymal fistula (PPF) have been described with different degrees of success. We detail the non-surgical management of a persistent PPF with temporary separate lung ventilation (SLV) via a double-lumen tube (DLT) in combination with talc pleurodesis as an approach in patients who are unable to undergo surgical treatment.

Infusion of intrathecal baclofen for acute withdrawal

2007 ◽  
Vol 107 (4) ◽  
pp. 878-880 ◽  
Author(s):  
Bradley S. Duhon ◽  
Joel D. Macdonald
Keyword(s):  
Early Recognition ◽  
Intrathecal Baclofen ◽  
Current Therapy ◽  
High Dose ◽  
Pump System ◽  
Lumbar Drain ◽  
Standard Patient ◽  
Baclofen Withdrawal ◽  
Life Threatening ◽  
Threatening Situation

✓ Acute baclofen withdrawal syndrome is a life-threatening situation that demands early recognition and urgent treatment. The current therapy of choice for this syndrome is administration of intravenous benzodiazepines, propofol, and chemical paralytic drugs until the intrathecal system can be restored. The authors present a novel technique for administering baclofen intrathecally using a lumbar drain and a standard patient-controlled analgesia pump (in continuous infusion mode). In one case, this method was used to wean the patient from high-dose intrathecal baclofen treatment. In a second case, this method was used as a temporizing measure until the indwelling pump system could be repaired. In both cases, the patients recovered to their neurological baseline level, and lasting consequences of serious withdrawal were avoided.

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