Baclofen withdrawal
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Baclofen withdrawal Hallucinations: 5 case reports Five patients with spastic paresis developed complex visual hallucinations after abrupt discontinuation of oral or intrathecal baclofen. A 73-year-old man had gradually withdrawn his treatment with oral baclofen 75 mg/day before receiving an intrathecal test bolus of baclofen 50µg. The test was positive and he underwent pump implantation under general anaesthesia; 19 hours before the surgery, he abruptly stopped his oral baclofen therapy [duration of treatment not stated]. Visual hallucinations appeared 31 hours after baclofen withdrawal and persisted despite administration of risperidone and diazepam. Intrathecal baclofen 75µg was then initiated and, 12 hours later, his hallucinations resolved. A few months later, abrupt interruption of intrathecal baclofen 123 µg/day for about 72 hours did not lead to hallucinations. A 31-year-old man, who was receiving oral baclofen 75 mg/day [duration of treatment not stated], abruptly discontinued his therapy prior to an intrathecal bolus test, and developed visual hallucinations 18 hours later. His hallucinations resolved about 3 hours later, after administration of an intrathecal bolus of baclofen 50µg. The optimal intrathecal baclofen dosage was determined to be 775 µg/day. After pump implantation, a fall caused catheter dislocation and similar visual hallucinations recurred 18 hours later [duration of intrathecal treatment not stated]. About 24 hours after the incident, he received oral baclofen 75 mg/day while he awaited surgery. Hallucinations resolved after about 12 hours. A 52-year-old man, who had been receiving intrathecal baclofen 800 µg/day for 5 years, required pump replacement and oral baclofen 100 mg/day was initiated. Before the procedure, he abruptly interrupted the oral treatment and developed hallucinations about 25 hours later [duration of oral treatment not stated]. After pump implantation about 3 hours later, a bolus of baclofen 100µg was administered and his symptoms started resolving. A few months after reinstitution of intrathecal therapy, he fell into a coma after ingesting several baclofen pills [dosage not stated]; intrathecal baclofen was abruptly discontinued. He gradually recovered from the coma after about 96 hours and reported recurrence of visual hallucinations. Within 3 hours of receiving a 100µg bolus of intrathecal baclofen, his hallucinations disappeared. A 41-year-old man, who was receiving oral baclofen 75 mg/day [duration of treatment not stated], abruptly interrupted therapy to undergo an intrathecal bolus test. He developed hallucinations 29 hours later. An intrathecal bolus of baclofen 50µg was administered after 1 hour and his hallucinations resolved within 2.5 hours. Review of his history revealed that he had not experienced hallucinations after an earlier gradual withdrawal of oral baclofen or after abrupt interruption of intrathecal baclofen for over 72 hours. A 48-year-old woman abruptly interrupted her therapy with oral baclofen 50 mg/day to undergo an intrathecal bolus test
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