Intrathecal baclofen in spinal spasticity: Frequency and severity of withdrawal syndrome

Background: intrathecal baclofen (itb) delivered by programmable pump devices represents an important modality for long-term treatment of severe spinal spasticity. objective: one of the serious adverse events is a withdrawal syndrome after sudden interruption of itb delivery. in this study,we analyzed the frequency and severity of this complication. treatment recommendations follow. study design: case study setting: academic medical center. methods: a total of 54 itb pumps were successfully implanted in 39 patients with severe intractable spasticity (24 with spinal cord injury,15 with multiple sclerosis,24 men,age range 21 – 59 years). results: eight patients developed a withdrawal syndrome on total a daily dose of itb between 90 – 420 μg/day. seven patients had catheter-related complications. in one patient,pump failure was observed due to its corrosion. within the group,baclofen withdrawal syndrome occurred once in 20.1 pump-years counted out of 160.4 pump-years of itb treatment. limitations: small sample size. conclusions: itb withdrawal syndrome is a rare but life-threatening event and prompt diagnosis before treatment initiation is critical. the reported events were mostly mild due to the acute treatment regime and probably due to a lower dose of itb. a prerequisite for successful itb treatment is a deep knowledge of complications and their prompt management in the hands of a multidisciplinary team in specialized centers. © 2015,american society of interventional pain physicians. all rights reserved.