Decrease of Consciousness Level Caused by Baclofen; a Case Report

Background: The side effects of drug use can have different consequences, from allergies to death. Among the drugs used to relieve chronic spasms is baclofen. Baclofen is a gamma-aminobutyric acid (GABA) agonist that is commonly administered orally and acts on the spinal cord. A few studies have been reported on mortality from baclofen. Case presentation: This present study reported a case of decreased consciousness and drowsiness, and severe decrease in muscle tone as a result of taking only 50 mg of baclofen.Conclusion: Level of consciousness can be decreased following the administration of baclofen but it is not permanent. Nurses are recommended to check albumin level of the blood as an intervening factor and pay attention to patients’ responses to baclofen.

The meaning of EEG indicators of loss of consciousness during anaesthesia and coma.

Raw EEG changes correlate well with the effects of anaesthetics on arousal. The purpose ofthe present paper is to analyse the significance of the EEG spectrograph. The alpha rhythm isa signature of the unconscious and according to the MAB hypothesis (Monoaminergic-Acetylcholinergic Balance) is an index of increased relative inhibitory muscarinic effects onmonoaminergic modulated conscious networks. The source of alpha rhythms varies, as doesthe type of unconscious information: from classical occipital alpha during resting state witheyes closed where no external visual information is processed, to states of unconsciousanaesthesia where alpha shifts to fronto-parietal networks. These are spontaneous oscillatorynetwork responses and the effects of GABA agonist anaesthetics increase the amplitude ofthese intrinsic rhythms. The hypothesis states that the concurrent presence of sustained deltaoscillations and alpha spindles signifies suppressed unconscious and conscious responsesrespectively, and permit neither implicit nor explicit cognition nor recollections. Further, themodel will be used to interpret EEG changes associated with more atypical anaesthetics andprovide reasons for the related cognitive effects. This will be based on the agents’pharmacological profiles and how they interact with these dual neuromodulatory systems.Evidence will also be drawn from EEG states associated with pathophysiology in coma andepilepsy. The pharmacological interpretation of EEG makes predictions of awareness indisorders of consciousness. The difficult circumstances of behaviourally inadequateindicators refers to situations of minimally conscious and in particular, vegetative stateswhere decision making is fraught with uncertainty.

Probing cortical excitability under GABAergic modulation

Cortical excitability, the variable response to a given cortical input, is widely studied in neuroscience, from slice experiments and in silico modeling work to human clinical settings. However, a unifying definition and a translational approach to the phenomenon are currently lacking. For example, at the onset of epileptic seizures, cortical excitability may impair resilience to perturbations (external or endogenous). In this study, we tested in vivo whether changes in cortical excitability quantified as evoked response to small perturbation corresponded to changes in resilience to larger perturbations. To do so, we used both cell-type circuit specific optogenetic stimulation in mice and direct intracranial stimulation in one human subject and quantified 1) evoked cortical responses to single pulses of varying intensity, and 2) evoked cortical facilitation and suppression to paired pulses at varying intervals. In the presence of a gamma-Aminobutyric acid (GABA) agonist or antagonist, we found that 1) cortical response to single pulses and 2) cortical facilitation decreased and increased, respectively. Additionally, using trains of opto-pulses in mice in the presence of a GABA agonist, we found increased resilience to the induction of seizures. With this study, we provide evidence for a tight correlation between cortical excitability and resilience, exploring a range of cortical dynamics, from physiological excitability, to pathological discharges. Our study carried out with two different stimulation methods in two species suggests that varying cortical excitability can be tracked with simple protocols involving minute short-lived perturbative stimuli.

Baclofen-Induced Encephalopathy in End Stage Renal Disease

Baclofen is a highly used centrally acting GABA agonist that continues to be an effective therapy for spasticity and chronic hiccups. The renally dependent excretion determines the circulating concentrations and guides effective dosing to decrease adverse reactions. Caution should be considered in administering baclofen to patients with decreased renal function. We present a patient with end stage renal disease on hemodialysis with recent baclofen ingestion who presented with toxic encephalopathy that was resolved with additional dialysis sessions.