Baclofen withdrawal

Background

  • Baclofen (Lioresal) is an anti-spasmodic that works on the as a GABA-b agonist
  • Primarily used in patients with Multiple Sclerosis, Cerebral Palsy and Spinal Cord injuries
  • Often administered intrathecally but does also have an oral formulation
  • Withdrawal symptoms thought to be caused by decreased GABA activation

Clinical Features

Baclofen withdrawal especially in the case of acute intrathecal pump failure may lead to:

Differential Diagnosis

Evaluation

  • History and Physical of Baclofen use
  • Examination of the pump
  • CPK levels
  • Electrolytes
  • CBC
  • LFTs
  • Coagulation studies

Management

  • High doses of benzodiazepines are the mainstay of treatment
  • High dose oral baclofen has been used but has been less effective
  • Intrathecal baclofen bolus can be attempted but overdoses are possible with this method
  • Dantrolene and cyproheptadine can also be considered but their efficacy is still unproven in this situation

Disposition

Admit:

  • Organ failure
  • Status epilepticus
  • Pump malfunction
  • Fever
  • Loss of consciousness

See Also

External Links

References