CSF Baclofen levels after intrathecal administration in severe spasticity

Sallerin-Caute, B.; Lazorthes, Y; Monsarrat, Bernard; Cros, J.; Bastide, Rémi

doi:10.1007/bf00265844

Cited by 51 publications

(23 citation statements)

References 13 publications

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“…However, the injection of just 50 mcg of intrathecal baclofen produces clinically significant improvement in spasticity in most patients. Sallerin-Caute, and associates noted that this dose is capable of producing a CSF level of 1,000 mcg/mL (which decreases to 100 mcg/mL at 6 hours) (19). Plasma levels in patients receiving intrathecal baclofen are expected to be 0-5 mcg/mL (1).…”

Section: Discussionmentioning

confidence: 97%

Baclofen Withdrawal Following Removal of an Intrathecal Baclofen Pump Despite Oral Baclofen Replacement

Greenberg

Hendrickson²

2003

Journal of Toxicology: Clinical Toxicology

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Intrathecal baclofen is used as a muscle relaxant and antispasmodic in cases of spasticity resulting from central nervous system trauma. The baclofen withdrawal syndrome may include hyperthermia, tachycardia, hypertension, seizures, altered mental status, and psychomotor agitation. We report a case in which the removal of a baclofen pump lead tothe development of severe withdrawal symptoms despite oral baclofen replacement therapy. In order to avoid the development of withdrawal, adequate doses of GABA agonist agents should be administered immediately prior to, and following, baclofen pump removal.

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Section: Discussionmentioning

confidence: 97%

Baclofen Withdrawal Following Removal of an Intrathecal Baclofen Pump Despite Oral Baclofen Replacement

Greenberg

Hendrickson²

2003

Journal of Toxicology: Clinical Toxicology

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“…Probably this is due to a too short low-dose period within the complex continuous regimen, which is supported by the intrathecal half-life of baclofen (4-5 h). 20 So even if the low dose period has been 4-5 h, the level of baclofen is not even reduced below 50%. Two patients (cases 1 and 8) received a drug holiday during complex continuous infusion.…”

Section: Discussionmentioning

confidence: 99%

The incidence and management of tolerance in intrathecal baclofen therapy

et al. 2009

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Study design: Retrospective study. Objectives: To study the incidence and management of tolerance in patients treated with intrathecal baclofen (ITB) therapy. Setting: Department of neurology and neurosurgery, University Medical Center Groningen, The Netherlands. Methods: Medical records of all patients who had received an implantable ITB pump at our clinic during 1991-2005 were reviewed. Results: A total of 37 patients (representing 116 pump years) were included. Mean follow-up time was 38 months (range 3-120 months). Baclofen dose increased in the first 18 months after implantation (Po0.05), and then stabilized around a mean dose of 350 mg per day. Eight patients (22%) developed tolerance, defined as a dose increase of 4100 mg per year. No predictive factors for development of tolerance could be determined. Three different treatment regimens for tolerant patients were analyzed. Altering the infusion mode from simple to complex continuous (n ¼ 6) had no effect on the development of tolerance. Pulsatile bolus infusion (n ¼ 1) and a drug holiday (n ¼ 2) were both effective in reducing the daily baclofen dose. Patients who needed surgical revision of the pump system because of mechanical failures (n ¼ 11) showed a significant dose decrease during the first month after revision, indicating that the preoperative dose increase most likely had been caused by the pump failure. Pumprelated complications occurred once per 10.5 years of ITB treatment. Drug-related side effects had an annual risk of 13.8%. The reported events were mostly mild. Conclusions: ITB therapy is effective and safe, also in the long term and causes tolerance in only 22% of the treated patients.

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“…The total continuous daily dose was decreased by 10%, to be cautious, avoiding high peak concentrations from the bolus infusion. The remaining daily dose was divided over six identical boluses, with a bolus interval of 4 h. This was based on the half-life of baclofen (4-5 h) and on own clinical experience, showing a mean duration of effect after an optimal ITB bolus of about 4 h. 15,16 The fixed bolus injection speed of the pump (Synchromed II; Medtronic) resulted in bolus durations between 3 and 5 min, depending on the magnitude of the bolus dose.…”

Section: Methodsmentioning

confidence: 99%

Tolerance to continuous intrathecal baclofen infusion can be reversed by pulsatile bolus infusion

2009

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Study design: Pilot study. Objective: To study the effect of pulsatile bolus infusion of intrathecal baclofen (ITB) on daily ITB dose, in patients showing dose increases, probably due to tolerance. Setting: Department of neurology and neurosurgery, University Medical Center Groningen, the Netherlands. Methods: Data on dosages and clinical efficacy were gathered from four patients who were switched from continuous to pulsatile bolus infusion of ITB, because of the probable diagnosis of tolerance to ITB. Results: Switching from continuous to pulsatile bolus infusion resulted in a decrease of the daily ITB dose, while the clinical effect could be kept stable, without introducing adverse events. Conclusion: Pulsatile bolus infusion of ITB seems to be an effective and safe treatment strategy to reverse the need for increasing ITB dosages in patients with the probable diagnosis of tolerance to ITB.

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CSF Baclofen levels after intrathecal administration in severe spasticity

Cited by 51 publications

References 13 publications

Baclofen Withdrawal Following Removal of an Intrathecal Baclofen Pump Despite Oral Baclofen Replacement

Baclofen Withdrawal Following Removal of an Intrathecal Baclofen Pump Despite Oral Baclofen Replacement

The incidence and management of tolerance in intrathecal baclofen therapy

Tolerance to continuous intrathecal baclofen infusion can be reversed by pulsatile bolus infusion

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