Baclofen toxicity presenting as myoclonic status epilepticus

Katyal, Roohi; Samkutty, Danny; Muzammil, Syeda Maria; Saucedo, Scott

doi:10.1212/cpj.0000000000000686

Cited by 8 publications

(6 citation statements)

References 5 publications

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“…8 The mechanism is unclear, but it has been postulated that baclofen can cause myoclonic status epilepticus by inactivating inhibitory interneurons in both pre-and post synapses, thereby lowering the threshold for seizures. 8 The dose of baclofen linked with adverse neurological effects is a cumulative dose of 10-20 mg, and the time for developing adverse neurological effects with baclofen is therefore largely dependent on when this cumulative dose is reached. 1,9,10 However, an alternate hypothesis suggests that there is a large, disproportionate accumulation of baclofen in the central nervous system of uremic patients, and neurological toxicity in this population can occur even at therapeutic doses of baclofen.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Paradoxically, in supra-therapeutic doses, it has been reported to lower seizure threshold and cause myoclonic movements. 8 The mechanism is unclear, but it has been postulated that baclofen can cause myoclonic status epilepticus by inactivating inhibitory interneurons in both pre-and post synapses, thereby lowering the threshold for seizures. 8 The dose of baclofen linked with adverse neurological effects is a cumulative dose of 10-20 mg, and the time for developing adverse neurological effects with baclofen is therefore largely dependent on when this cumulative dose is reached.…”

Section: Discussionmentioning

confidence: 99%

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Baclofen-induced myoclonus in patients with renal impairment: A case series

Vidanapathirana,

Palliyaguruge,

Wijewickrama

2023

SAGE Open Medical Case Reports

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Baclofen is a derivative of gamma amino butyric acid and is used for control of pain and muscular spasms. It is primarily excreted via the kidneys. In patients with impaired renal functions, the half-life of baclofen is prolonged and symptoms of toxicity can occur with normal doses. Commonly reported symptoms of baclofen toxicity are somnolence, altered mentation, seizures and respiratory depression. Myoclonus secondary to baclofen toxicity is scarcely reported. This case series describes two patients with chronic kidney disease (CKD) who were prescribed regular doses of baclofen for analgesia, and subsequently developed generalized myoclonus. The symptoms resolved with omission of baclofen and haemodialysis. There is currently no consensus on dose modification of baclofen in renal impairment for prevention of adverse neurological events. However, considering the surmounting evidence for low threshold of baclofen toxicity in CKD, dose adjustment protocols or consensus on contraindication need to be established.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Baclofen-induced myoclonus in patients with renal impairment: A case series

Vidanapathirana,

Palliyaguruge,

Wijewickrama

2023

SAGE Open Medical Case Reports

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“…Острые отравления баклофеном могут сопровождаться бессонницей, нарушением сознания, комой [19] и нарушением дыхания. Развивается головокружение, галлюцинации и тахиаритмии [20], гиперсаливация, тошнота, рвота, диарея, отмечаются нарушения аккомодации, потеря корнеального рефлекса, появление мышечной гипотонии и клонических судорог [21,22] После введения препаратов животных выходили из наркоза и оставляли в виварии при условии свободного доступа к воде, но без пищи. Через 3 часа снова проводили анестезию с последующей эвтаназией.…”

Section: гистоморфологические изменения в легких при отравлении баклоunclassified

Histomorphological changes in the lungs induced by poisoning with baclofen and its combination with ethanol (experimental study)

Romanova

Леонидовна²,

Сундуков

et al. 2020

Russian Journal of Forensic Medicine

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Aim. detection and assessment of histomorphological changes in the lungs in acute poisoning with Baclofen and its combination with ethanol 3 hours after the poisoning. Material and methods. Experimental studies were conducted on 15 Wistar rats divided into 3 groups. The group of controls -1 included 5 intact animals, group 2 was treated to Baclofen at a dosage of 85 mg/kg, group 3 was treated to combination of Baclofen (85 mg / kg) and ethanol (7 ml/kg 40% ethanol) Results. No pathological changes were observed in the lungs of the controls. In both experimental groups capillary and venous plethora, sludge, atelectasis and deselectasis, emphysema, infiltration of intraalveolar septi by WBC, thickening of intraalveolar septi due to edema were detected. Secretion was observed in the bronchioles of the second experimental group of animals. Conclusion. As a result of the study we identified a complex of pathological changes in the lungs of experimental animals in the early period after the administration of Baclofen, which included circulatory disorders in all the elements of the microcirculatory bed (plethora of capilaries, venules), emphysema, atelectases and distelectases, infiltration of intraalveolar septi by WBC and thickening of intraalveolar septi due to edema. In order to quantify the severity of histomorphological changes in the lungs a morphometric study is required.

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