Baclofen
- PDF / 176,202 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 4 Downloads / 180 Views
S
Withdrawal syndrome secondary to inadvertent pocket fill: case report A 39-year-old woman developed withdrawal syndrome (involving epileptic episodes secondary to increased spasticity, generalised discomfort and increased sweating) secondary to inadvertent pocket-fill during treatment with baclofen for severe spasticity. The woman had experienced a cardiac arrest on 11 February 1999 following heroin overdose, which had resulted in post-anoxic encephalopathy. She had developed severe tetra-spasticity within months. She had severe spasticity mainly in her left hemi-body and lower limbs. Four months later, she had received oral baclofen which was ineffective. Therefore, intrathecal baclofen 50µg was tested, which resulted in a notable decline in the spasticity of her lower limbs along with a very little effect on the upper limbs. The clinical improvement was judged to be satisfactory; therefore, a pump was implanted on 23 July 1999 to administer baclofen via intrathecal route. The initial daily dose of baclofen 200µg was up-titrated to maintain the required clinical response. In spite of additional injections of Botulinum toxin-A [Botox], the daily dose of baclofen needed to be increased to 500µg within a few months, and further to 600µg in 2000, 980µg in 2003 and 1050µg (concentration of 2000 µg/mL) from September 2010. In spite of incomplete control of the spasticity of her upper limbs and cervical dystonia, higher daily doses of baclofen were deemed inappropriate. Due to the high flow rates, the pump battery exhausted in 4 to 5 years, and the pump was replaced in 2005, 2011 and 2015. Her general clinical condition deteriorated over the years. Due to the increasing feeding difficulty, a percutaneous endoscopic gastrostomy (PEG) tube was implanted in 2006. Owing to repetitive urinary infections and the presence of a neurogenic bladder, a suprapubic cystostomy, followed by a total cystectomy (Bricker) was performed in April 2007. She also experienced epileptic attacks, which increased despite the administration of multiple unspecified anti-epileptic medications. On 4 April 2017, she underwent an uneventful pump refill, where 3.5mL was retrieved for a calculated residual volume in the reservoir of 3.3mL. As per the standard procedure, 40mL of baclofen (2000 µg/mL) was injected in the reservoir, but without ultrasound monitoring. The programming remained unchanged (i.e. 1050 µg/day of baclofen, flow rate of 575 µL/day). The subsequent refill session was scheduled for 13 June 2017, as the pump indicated an alarm date on 15 June 2017 (for a reservoir residual volume set at 2mL). She was monitored for 90 minutes after the refill, following which she was discharged, as there was no apparent change in her clinical condition. However, on 12 June 2017 she was brought to another hospital, where the medical personnel were unfamiliar with the delivery of intrathecal baclofen. It was estimated that her general condition had started to decline around 5 June 2017. Her parents stated that it was the first time she had been so unwe
Data Loading...
