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  • Title: Intrathecal Baclofen in Spinal Spasticity: Frequency and Severity of Withdrawal Syndrome.
    Author: Stetkarova I, Brabec K, Vasko P, Mencl L.
    Journal: Pain Physician; 2015; 18(4):E633-41. PubMed ID: 26218954.
    Abstract:
    BACKGROUND: Intrathecal baclofen (ITB) delivered by programmable pump devices represents an important modality for long-term treatment of severe spinal spasticity. OBJECTIVE: One of the serious adverse events is a withdrawal syndrome after sudden interruption of ITB delivery. In this study, we analyzed the frequency and severity of this complication. Treatment recommendations follow. STUDY DESIGN: Case study. SETTING: Academic medical center. METHODS: A total of 54 ITB pumps were successfully implanted in 39 patients with severe intractable spasticity (24 with spinal cord injury, 15 with multiple sclerosis, 24 men, age range 21-59 years). RESULTS: Eight patients developed a withdrawal syndrome on total a daily dose of ITB between 90-420 μg/day. Seven patients had catheter-related complications. In one patient, pump failure was observed due to its corrosion. Within the group, baclofen withdrawal syndrome occurred once in 20.1 pump-years counted out of 160.4 pump-years of ITB treatment. LIMITATIONS: Small sample size. CONCLUSIONS: ITB withdrawal syndrome is a rare but life-threatening event and prompt diagnosis before treatment initiation is critical. The reported events were mostly mild due to the acute treatment regime and probably due to a lower dose of ITB. A prerequisite for successful ITB treatment is a deep knowledge of complications and their prompt management in the hands of a multidisciplinary team in specialized centers.
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