Monitoring of Creatinine Kinase During Weaning of Intrathecal Baclofen and with Symptoms of Early Withdrawal:

Unusual Painful Muscle Spasm in a Dialysis-Dependent Patient with Progressive Cervical Kyphosis

We herein report a case of cervical myelopathy due to destructive spondyloarthropathy (DSA) with an unusual painful muscle spasm. A 51-year-old man presented to our hospital due to numbness in the hands and progressive gait disturbance. The patient underwent laminoplasty for cervical myelopathy. One and a half years after surgery, the patient developed progressive kyphosis of the cervical spine and increasing spastisity. He also started to suffer from intractable pain associated with a muscle spasm. A blood analysis revealed marked CK elevation. The patient underwent 2-stage circumferential decompression and fusion. After the revision procedure, his symptoms improved, and his serum CK level normalized. Physicians should be alert to the possibility of pain associated with an excessive muscle spasm in cervical myelopathy patients.

Delirium Associated With Baclofen Withdrawal: A Review of Common Presentations and Management Strategies

The authors reviewed 23 published cases of psychiatric symptoms in association with baclofen withdrawal. Delirium, and not other functional psychiatric conditions, arose secondarily from abrupt baclofen cessation. Vulnerability to baclofen-withdrawal delirium appeared to be greater in individuals who received chronic baclofen therapy. Baclofen-withdrawal delirium can be difficult to distinguish from delirium of other etiologies, and unrecognized and inadequately treated baclofen-withdrawal delirium is associated with significant morbidity and mortality. Complete resolution of delirium symptoms was possible with reinstatement of baclofen. The clinical management of patients experiencing baclofen-withdrawal delirium includes supportive interventions to reduce complications of delirium until symptoms resolve.

Intrathecal baclofen withdrawal syndrome caused by low residual volume in the pump reservoir: A report of 2 cases

Intrathecal baclofen (ITB) is an effective treatment for spasticity caused by spinal or cerebral pathologies. Severe withdrawal symptoms can result, however, if ITB is abruptly withdrawn as a result of equipment malfunctions or human error. We describe 2 cases of severe ITB withdrawal syndrome. In the first case, the symptoms appeared 5 months after pump placement, when residual volume was 2.0 mL; in the second case, symptoms appeared 2 months after the replacement of a new pump, when residual volume was 0.9 mL. In both cases, there was no evidence of system malfunction or human error. The syndrome occurred from up to 72 hours before the scheduled refilling procedure, and the residual volume in the Medtronic SynchroMed EL pump reservoir was either at, or significantly lower than, the recommended 2 mL. These cases suggest that the SynchroMed EL pump reservoir should be refilled, to avoid potentially serious consequences, when the residual volume is not lower than 3 mL by programming the alarm to sound at a volume larger than the recommended 2 mL.