Paralytic ileus: A complication after intrathecal baclofen therapy

Intrathecal Therapies

Intrathecal baclofen therapy is a well-established technique for spasticity management. This article briefly reviews the pharmacology of intrathecal baclofen as well as customary approach for utilization of this targeted drug delivery concept. Following these descriptions, four unusual presentations will be described, including the need for initial trialing, patient-directed boluses during chronic intrathecal baclofen therapy, use of medications other than baclofen for intrathecal therapy in spastic patients, and intraventricular baclofen delivery. These hypothetical cases are provided in an effort to expand the use of targeted drug delivery to larger population of spastic patients.

Baclofen systemic toxicity: Experimental histopathological and biochemical study

OBJECTIVE

The present study was designed to highlight the toxic impact of baclofen on both biochemical and histopathological aspects in rats' liver, gastric, lung, kidney, and brain tissues.

METHODS

The study was performed on 30 healthy adult male albino rats divided into four groups with 5 rats in each control group, and 10 rats in either experimental groups (two experimental and two control groups). Five rats (negative control) were kept in a quite non-stressful environment, provided with food ad libitum and free access to water. Normal saline (1 ml) was given orally as placebo in the positive control group ( n = 5). Experimental group III, baclofen acute toxicity group (10 rats): Each animal received a single dose of lethal dose (LD₅₀) of baclofen orally by gavage. It equals 145 mg/kg body weight. The rats were observed for acute toxicity manifestations as well as for LD₅₀ deaths. Group IV, (baclofen-dependent group, 10 rats): Each animal received baclofen (1/10th LD₅₀) in gradually increasing doses for 1 month.

RESULTS

The levels of blood urea nitrogen, creatinine kinase, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transpeptidase, cardiac troponin I, and prothrombin time in both baclofen-treated groups showed significant elevation when compared to controls. There were brain, lung, gastric, hepatic, and renal histopathological changes in baclofen-treated rats whose severity varied between the two experimental groups.

CONCLUSION AND RECOMMENDATION

Baclofen toxicity is an under diagnosed emergency. Physicians should consider baclofen toxicity in users having hepatorenal dysfunction, presenting with altered mental status, bradycardia, and hypotension.

Intestinal pseudo-obstruction following oral baclofen: An unusual complication

Baclofen is a gamma- aminobutyric acid B (GABA B) agonist used for the management of spasticity associated with spinal cord injury. Oral baclofen might cause constipation, but intestinal pseudo-obstruction is very rare. We report a 50-year-old male with spasticity following cervical discectomy (C3-4) on oral baclofen for 6 months with intestinal pseudo-obstruction. He had undergone open suprapubic cystostomy for traumatic urethral injury, 45 days prior to the presentation and adhesive intestinal obstruction was also considered a possibility. However, there were no air fluid levels on abdominal radiographs and ultrasound abdomen was non-contributory. Withdrawal of baclofen was therapeutic in this patient. This case is being reported to highlight the rare possibility of oral baclofen induced intestinal pseudo-obstruction.

Intrathecal baclofen for autonomic instability due to spinal cord injury

Autonomic dysreflexia may occur following spinal cord injury above mid-thoracic level, commonly developing in the early posttraumatic period. Cardiovascular dysregulation is the most prominent feature, characterized by paroxysmal high blood pressure attacks, which are precipitated by distension of urinary bladder or bowels, skin wounds, or increased spastic muscle tone. Severe drops in blood pressure may occur in orthostatic conditions. Baclofen is effective for treating spasticity. While orally administered baclofen often fails to alleviate severe spasticity adequately, intrathecal baclofen (ITB) is more effective and thus is being used increasingly. A 61-year-old male sustained a cervical spinal cord injury, subsequently developing severe spastic tetraparesis, predominantly in the legs. Some 30 years later he experienced marked spasms of the muscles of the abdominal wall, leading to extreme fluctuations of blood pressure. After positive evaluation with ITB the patient underwent implantation of a pump-catheter-system for continuous ITB application. Abdominal wall spasms ceased entirely with a daily dose of 190 microg ITB, accompanied by a sustained normotensive blood pressure profile. However, spasms reoccurred after inadvertent reduction of ITB flow when increasing the pump's ITB concentration but subsided again when the optimal antispastic dose was reestablished. Baclofen per se has the potential of lowering blood pressure. In this patient, however, ITB treatment enabled permanent stabilization of insidious blood pressure fluctuations. It would appear that suppression of abdominal spasms prevented the triggering of dysautonomic crises. This case demonstrates that ITB administration may help to stabilize autonomic dysreflexia and orthostatic hypotension in patients with spinal cord lesions.