Abstract | OBJECTIVE: To suggest guidelines for the prevention, recognition, and management of a life-threatening syndrome (high fever, altered mental status, profound muscular rigidity that sometimes progressed to fatal rhabdomyolysis) in patients who experience the abrupt withdrawal of intrathecal baclofen (ITB) therapy. DESIGN: Retrospective literature and safety-file review. SETTING: Expert panel drawn from physiatry, neurology, and neurosurgery. PARTICIPANTS: Experienced users of ITB therapy in the pediatric and adult populations in the United States. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We reviewed literature reports, MedWatch reports to the US Food and Drug Administration, and our own experiences. We critically analyzed patient management and drug therapy in the context of the pharmacology of baclofen and other antispastic agents. RESULTS: CONCLUSIONS: Most episodes of severe ITB withdrawal were preventable. Patients at risk can be identified and educated prospectively and given medication for emergency use. Treatment with GABAergic agonist drugs may prevent potentially fatal sequelae.
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Authors | Robert J Coffey, Terence S Edgar, Gerard E Francisco, Virginia Graziani, Jay M Meythaler, Patrick M Ridgely, Saud A Sadiq, Michael S Turner |
Journal | Archives of physical medicine and rehabilitation
(Arch Phys Med Rehabil)
Vol. 83
Issue 6
Pg. 735-41
(Jun 2002)
ISSN: 0003-9993 [Print] United States |
PMID | 12048649
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
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Copyright | Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation |
Chemical References |
- Anti-Anxiety Agents
- GABA Agonists
- Benzodiazepines
- Baclofen
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Topics |
- Anti-Anxiety Agents
(therapeutic use)
- Autonomic Dysreflexia
(diagnosis)
- Baclofen
(adverse effects)
- Benzodiazepines
- Diagnosis, Differential
- GABA Agonists
(adverse effects)
- Humans
- Infusion Pumps, Implantable
- Malignant Hyperthermia
(diagnosis)
- Neuroleptic Malignant Syndrome
(diagnosis)
- Retrospective Studies
- Risk Factors
- Substance Withdrawal Syndrome
(diagnosis, drug therapy, etiology, prevention & control)
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