Article

Individuals who are treated with intrathecal Baclofen (ITB) pump
delivery system for intractable spasticity can suffer from severe morbidity as a
result of acute overdose or withdrawal of ITB, which can also be life
threatening. Current literature has a number of single case studies with
different approaches to the management in such states. OBJECTIVES: The aim of
this article is to consolidate available evidence and develop treatment pathways
for acute ITB overdose and withdrawal states. METHODS: We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library databases using the keywords
'intrathecal', 'baclofen', 'withdrawal', 'overdose' to identify studies
(published up to December 2010) that focused on presentation or treatment of
acute overdose and withdrawal state in ITB therapy. Only original articles in
English involving adult population were included. RESULTS: Initial search
revealed 130 articles. After reading the abstract, 13 studies on ITB overdose and
23 studies on ITB withdrawal were deemed suitable for inclusion. All studies were
either single-case studies or case series. CONCLUSION:
Acute ITB overdose is
managed with immediate cessation of baclofen delivery through the system,
reducing the baclofen load by cerebrospinal fluid aspiration and by providing
supportive treatment in an intensive care setting. There is no specific antidote
for reversing overdose symptoms. Acute ITB withdrawal is managed by restoring the
delivery of ITB, providing supportive care in an intensive care setting and using
drugs like low dose propofol or benzodiazepines in selected cases. Early
involvement of ITB physicians is strongly recommended.

Langue : ANGLAIS