E. M. Delhaas

Leiden University Medical Center

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J. H. C. Voormolen

Leiden University Medical Center

J.J. van Hilten

Leiden University Medical Center

Willem‐Johan T. van de Beek

Leiden University Medical Center

J. R. B. J. Brouwers

University of Groningen

Jorrit I. Hoff

St. Antonius Ziekenhuis

R. J. Boskma

's Heeren Loo

Harm Lip

University of Groningen

J.J.M. Kums

Isala

J.J. Bob van Hilten

Delft University of Technology

Alexander G. Munts

Leiden University Medical Center

Cooperative Institutions

Leiden University Medical Center

Leiden University

Hahnemann University Hospital

University of Groningen

Ziekenhuis Groep Twente

University Medical Center Groningen

Utrecht University

Academic Medical Center

Genomics England

Hospital Universitario Virgen del Rocío

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Intrathecal baclofen overdose: report of 7 events in 5 patients and review of the literature.

PubMed (1991)

E. M. Delhaas J. R. B. J. Brouwers

This study is intended to alert the clinician to the insidious symptoms of baclofen overdose, its prevention and treatment. In a group of 43 patients suffering from previously intractable spasticity and a total treatment time of 2,422 weeks, 7 events of intrathecal baclofen overdose happened in 5 patients. On two occasions, a bolus injection caused an overdose (dose 50 and 280 micrograms). The 5 events during continuous infusion intoxication only happened in high dosed patients. The overdose symptoms occurred in one patient when she was lying in supine position (800 micrograms/24 h), in another patient after repair of CSF leakage by an autologous epidural bloodpatch (1,920 micrograms/24 h) and in tolerant patients, once during maximal dose adjustments (2,400 micrograms/24 h) and twice ca. 6 hours following reinitiation of the intrathecal baclofen infusion after a "drug holiday" treatment (27 and 55 micrograms/h). We could not confirm the reported similarity of baclofen overdose with the anticholinergic syndrome. Especially, the bradycardia and hypotension are more in accord with the reported clinical picture of oral baclofen overdose. In the absence of a pure baclofen antagonist and the varying symptoms of intrathecal baclofen, intoxication make rational treatment difficult. We observed that the advised physostigmine therapy is not always effective and safe. The occasionally doubtful antidotal benefits of physostigmine must be weighted against major side-effects. The classical approach of decreasing the absorption of a drug by lowering baclofen levels in the CSF by lumbar puncture drainage was successful. This approach together with conservative symptomatic treatment in an intensive care environment is probably a better and safer alternative than physostigmine alone as an antidote.

Baclofen

Bolus (digestion)

Muscle relaxant

Supine position

Physostigmine

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Citations (51)

Clinimetric issues of screening for responsiveness to intrathecal baclofen in dystonia

Journal of Neural Transmission (1999)

J.J. van Hilten Jorrit I. Hoff M. C. Thang M. M. S. van de Meerakker J. H. C. Voormolen

Baclofen

Bolus (digestion)

10.1007/s007020050213

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Citations (14)

Baclofen pumps: comment on Anderson et al.

Pediatric Anesthesia (2003)

E. M. Delhaas S. Goslinga

10.1046/j.1460-9592.2003.01147_1.x

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Citations (0)

Intrathecal baclofen in severe spasticity

Clinical Neurology and Neurosurgery (1990)

E. M. Delhaas J.M. Spit J.J.M. Kums

Hostility

10.1016/0303-8467(90)90118-o

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Citations (1)

Intrathecal baclofen for dystonia of complex regional pain syndrome

Pain (2009)

van Rijn Alexander G. Munts Johan Marinus J. H. C. Voormolen Kees S. de Boer

Dystonia in complex regional pain syndrome (CRPS) responds poorly to treatment. Intrathecal baclofen (ITB) may improve this type of dystonia, but information on its efficacy and safety is limited. A single-blind, placebo-run-in, dose-escalation study was carried out in 42 CRPS patients to evaluate whether dystonia responds to ITB. Thirty-six of the 38 patients, who met the responder criteria received a pump for continuous ITB administration, and were followed up for 12 months to assess long-term efficacy and safety (open-label study). Primary outcome measures were global dystonia severity (both studies) and dystonia-related functional limitations (open-label study). The dose-escalation study showed a dose-effect of baclofen on dystonia severity in 31 patients in doses up to 450 microg/day. One patient did not respond to treatment in the dose-escalation study and three patients dropped out. Thirty-six patients entered the open-label study. Intention-to-treat analysis revealed a substantial improvement in patient and assessor-rated dystonia scores, pain, disability and quality-of-life (Qol) at 12 months. The response in the dose-escalation study did not predict the response to ITB in the open-label study. Eighty-nine adverse events occurred in 26 patients and were related to baclofen (n=19), pump/catheter system defects (n=52), or could not be specified (n=18). The pump was explanted in six patients during the follow-up phase. Dystonia, pain, disability and Qol all improved on ITB and remained efficacious over a period of one year. However, ITB is associated with a high complication rate in this patient group, and methods to improve patient selection and catheter-pump integrity are warranted.

Baclofen

Intrathecal

10.1016/j.pain.2009.01.014

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Citations (106)

Diagnostic criteria used in studies of reflex sympathetic dystrophy

Neurology (2002)

W. J. T. Van de Beek Robert J. Schwartzman S. I. van Nes E. M. Delhaas J.J. van Hilten

Objective: Assessment of the diagnostic criteria of reflex sympathetic dystrophy (RSD) and evaluation of the impact of the introduction of the diagnostic criteria of complex regional pain syndrome (CRPS) on the international application of diagnostic criteria of RSD.

Dystrophy

10.1212/wnl.58.4.522

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Citations (64)

Intrathecal Baclofen for the Treatment of Dystonia in Patients with Reflex Sympathetic Dystrophy

New England Journal of Medicine (2000)

Bob J. van Hilten Willem‐Johan T. van de Beek Jorrit I. Hoff J. H. C. Voormolen E. M. Delhaas

Patients with reflex sympathetic dystrophy (also known as the complex regional pain syndrome) may have dystonia, which is often unresponsive to treatment. Some forms of dystonia respond to the intrathecal administration of baclofen, a specific gamma-aminobutyric acid-receptor (type B) agonist that inhibits sensory input to the neurons of the spinal cord. We evaluated this treatment in seven women who had reflex sympathetic dystrophy with multifocal or generalized tonic dystonia. First, we performed a double-blind, randomized, controlled crossover trial of bolus intrathecal injections of 25, 50, and 75 microg of baclofen and placebo. Changes in the severity of dystonia were assessed by the woman and by an investigator after each injection. In the second phase of the study, six of the women received a subcutaneous pump for continuous intrathecal administration of baclofen and were followed for 0.5 to 3 years.In six women, bolus injections of 50 and 75 microg of baclofen resulted in complete or partial resolution of focal dystonia of the hands but little improvement in dystonia of the legs. During continuous therapy, three women regained normal hand function, and two of these three women regained the ability to walk (one only indoors). In one woman who received continuous therapy, the pain and violent jerks disappeared and the dystonic posturing of the arm decreased. In two women the spasms or restlessness of the legs decreased, without any change in the dystonia.In some patients, the dystonia associated with reflex sympathetic dystrophy responds markedly to intrathecal baclofen.

Baclofen

Dystrophy

Intrathecal

10.1056/nejm200008313430905

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Citations (309)

Intrathecal baclofen treatment of dystonia in reflex sympathetic dystrophy

Movement Disorders (2002)

J.J. Bob van Hilten Willem‐Johan T. van de Beek J. H. C. Voormolen E. M. Delhaas

10.1002/mds.10210

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Citations (3)