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Neurocritical Care

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01.04.2015 | Practical Pearl

Dexmedetomidine for Acute Baclofen Withdrawal

verfasst von: Simon Morr, Christopher M. Heard, Veetai Li, Renée M. Reynolds

Erschienen in: Neurocritical Care | Ausgabe 2/2015

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Abstract

Background

Intrathecal baclofen is widely accepted as a treatment option for severe spasticity through its γ-Aminobutyric acid-B (GABA_B ) agonist properties. Abrupt cessation can lead to severe and life-threatening withdrawal characterized by altered mental status, autonomic dysreflexia, rigidity, and seizures. This symptomatic presentation is similar to alcohol withdrawal, which is mediated by modification of GABA_A expression. Use of the α2-adrenergic agonist dexmedetomidine for the treatment of ethanol withdrawal has been widely reported, raising the question of its potential role in baclofen withdrawal. We present a case of the successful treatment of acute severe baclofen withdrawal with a dexmedetomidine infusion.

Methods

A 15-year-old patient with spastic quadriparesis and cerebral palsy underwent unexpected removal of his baclofen pump due to an infection that was encountered during a planned pump revision. Following removal, he was placed on high dose enteral baclofen every 6 h. Despite further benzodiazepine supplementation, he had progressive hemodynamic instability, severe rebound spasticity, and intermittent spontaneous clonus consistent with baclofen withdrawal. A dexmedetomidine infusion was titrated to a peak dose of 16 mcg per hour with successful treatment of withdrawal symptoms.

Results

The patient became normotensive without tachycardia. Tone and agitation improved.

Conclusion

Dexmedetomidine is to our knowledge a previously unreported option for treatment of acute severe baclofen withdrawal. We report a case of safe and efficacious use in a patient with spastic quadriparesis on chronic intrathecal baclofen. Scientifically rigorous comparison with other options remains to be performed.

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Titel: Dexmedetomidine for Acute Baclofen Withdrawal
verfasst von: Simon Morr
Christopher M. Heard
Veetai Li
Renée M. Reynolds
Publikationsdatum: 01.04.2015
Verlag: Springer US
Erschienen in: Neurocritical Care / Ausgabe 2/2015
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-014-0083-8

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