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Baclofen withdrawal
From WikEM
Contents
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:
- High Fevers
- Confusion
- Altered mental status
- Muscle stiffness
- Seizures
- Rhabdomyolysis
- Multiple organ system failure
- Death
Differential Diagnosis
- Sepsis
- Meningitis
- Epilepsy
- Autonomic dysreflexia
- Neuroleptic malignant syndrome
- Malignant hyperthermia
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
