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Excerpt
A 21-yr-old man with C5 ASIA B spastic tetraplegia using a baclofen pump and intrathecal catheter infusion system for spasticity management presented with a 1-day history of rigor, diaphoresis, confusion, and severe spasticity. Initial evaluation revealed signs of baclofen withdrawal, hyperthermia, and rhabdomyolysis. Work-up for infection showed elevated white blood cell count and positive urine cultures. Telemetric and radiographic studies confirmed a functional pump and catheter system. Detection of low reservoir volume necessitated a pump refill, even though the volume had not reached alarm level. Oral antispasmodic agents and benzodiazepines were used to control initial withdrawal symptoms, and spasticity eventually returned to baseline after pump refill. He remained febrile for 8 days despite decline in white blood cell count with intravenous antibiotics. He also had a sharp rise in serum creatinine phosphokinase level and developed acute renal insufficiency, which reversed with intravenous hydration. Abrupt baclofen withdrawal can occur in the absence of obvious mechanical defect in the pump and catheter system. Probable causes include underinfusion during low-volume state and fibrin deposit near the catheter tip. Baclofen withdrawal can induce rebound hypertonia and initiate a cascade of potentially serious complications. Prompt recognition and treatment of symptoms are advised.
