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European Journal of Physical and... Sep 2010Spasticity is a common symptom observed after pyramidal system lesion. The treatment of spasticity has considerably changed during last years, notably with the... (Review)
Review
Spasticity is a common symptom observed after pyramidal system lesion. The treatment of spasticity has considerably changed during last years, notably with the generalization of Botulinum toxin use. However, the treatment of spasticity should consider all therapeutic possibility in accordance with patient status and objective. Drugs are only a part of the treatment and physical therapy must always be used. Others treatments such as surgery, orthosis, occupational therapy must also be discussed individually. Several guidelines are now available for Botulinum toxin treatment but only the French guidelines consider all drug therapies. This review addresses the different drugs commonly used on the basis of an extensive review of literature. Some facts are clearly established by randomized controlled trials but a certain number of questions remains unclear and only clinical experience and consensus can guide injectors.
Topics: Administration, Oral; Baclofen; Botulinum Toxins, Type A; Clonidine; Humans; Injections, Spinal; Muscle Relaxants, Central; Muscle Spasticity; Neuromuscular Agents
PubMed: 20927006
DOI: No ID Found -
CJEM Mar 2023
Topics: Humans; Alcoholism; Baclofen; Ondansetron; Alcohol Drinking
PubMed: 36689190
DOI: 10.1007/s43678-023-00448-8 -
Zhurnal Voprosy Neirokhirurgii Imeni N.... 2017To analyze complications of intrathecal baclofen therapy and identify high-risk groups.
AIM
To analyze complications of intrathecal baclofen therapy and identify high-risk groups.
MATERIAL AND METHODS
We implanted 52 pumps to spastic patients for chronic intrathecal baclofen infusion. Two groups of patients were distinguished: 23 patients with spinal spasticity (group 1) and 29 patients with cerebral spasticity (group 2). The mean patient age was 37.2±14.6 years in group 1 and 17.3±10.3 years in group 2. Surgery was performed according to a standard procedure. A Medstream (Codman) pump was implanted in 10 cases, and a Synchromed II (Medtronic) pump was implanted in the remaining 42 cases.
RESULTS AND DISCUSSION
Complications developed in 12 (23%) patients. We divided complications into 3 groups: baclofen underdose, baclofen overdose, and others. Insufficiency of intrathecal therapy was observed in 7 cases, which was caused by catheter migration (5 cases) and pump dysfunction (2 cases). In one case, baclofen overdose was observed after air travel. Other complications included 4 cases of persistent peri-implant seroma and infectious complications. Groups with a high risk of complications were identified based on an analysis of the results. Patients with severe dystonia of the trunk muscles have an increased risk of spinal catheter migration. Pronounced communicating hydrocephalus is associated with the risk of cerebrospinal fluid leak through a catheter shaft channel. Weakness of the axial musculature can lead to progression of scoliotic deformity.
CONCLUSION
In some cases, chronic intrathecal baclofen therapy can be accompanied by various complications. This technique should be carefully used in patients from high-risk groups.
Topics: Adult; Baclofen; Brain Diseases; Central Nervous System Infections; Female; Humans; Infusions, Spinal; Male; Middle Aged; Seroma; Spinal Stenosis
PubMed: 28291215
DOI: 10.17116/neiro201780763-69 -
The Spine Journal : Official Journal of... Mar 2023Traumatic spinal cord injury (SCI) leads to severe motor and sensory functional impairments that affect personal and social behaviors. Medical advancements have improved...
BACKGROUND CONTEXT
Traumatic spinal cord injury (SCI) leads to severe motor and sensory functional impairments that affect personal and social behaviors. Medical advancements have improved supportive therapeutic measures for SCI patients, but no effective neuroregenerative therapeutic options exist to date. Deficits in motor function are the most visible consequence of SCI. However, other complications, as spasticity, produce a significant impact on SCI patient's welfare. Baclofen, a GABA agonist, is the most effective drug for spasticity treatment. Interestingly, emerging data reveals that baclofen can also play a role on neuroprotection and regeneration after SCI.
PURPOSE
The goal of this study was to understand the potential of baclofen as a treatment to promote recovery after SCI.
STUDY DESIGN
We used a pre-clinical SCI mouse model with the administration of baclofen 1 mg/Kg at different time-points after injury.
METHODS
Behavior analysis (locomotor and bladder function) were performed during nine weeks of the in vivo experiment. Afterwards, spinal cords were collected and processed for histological and molecular analysis.
RESULTS
Our data showed that baclofen leads to locomotor improvements in mice when its administered acutely after SCI. Moreover, baclofen administration also led to improved bladder function control in all experimental groups. Interestingly, acute baclofen administration modulates microglia activation state and levels of circulating chemokines and cytokines, suggesting a putative role of baclofen in the modulation of the immune response.
CONCLUSIONS
Although further studies must be performed to understand the mechanisms that underlie the functional improvements produced by baclofen, our data shed light into the pharmacological potential of baclofen to promote recovery after SCI.
CLINICAL RELEVANCE
Our outcomes revealed that baclofen, a well-known drug used for spasticity management, improves the motor performance after SCI in a pre-clinical animal model. Our data opens new avenues for pharmacological strategies design to promote SCI recovery.
Topics: Mice; Animals; Baclofen; Spinal Cord Injuries; Spinal Cord; Recovery of Function
PubMed: 36155240
DOI: 10.1016/j.spinee.2022.09.007 -
Indian Journal of Pharmacology 2014Benzodiazepines (BZDs) are the first-line drugs in alcohol-withdrawal syndrome (AWS). Baclofen, a gamma-aminobutyric acidB (GABAB) agonist, controls withdrawal symptoms... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Benzodiazepines (BZDs) are the first-line drugs in alcohol-withdrawal syndrome (AWS). Baclofen, a gamma-aminobutyric acidB (GABAB) agonist, controls withdrawal symptoms without causing significant adverse effects. The objective of this study was to compare the cost-effectiveness of baclofen and chlordiazepoxide in the management of uncomplicated AWS.
MATERIALS AND METHODS
This was a randomized, open label, standard controlled, parallel group study of cost-effectiveness analysis (CEA) of baclofen and chlordiazepoxide in 60 participants with uncomplicated AWS. Clinical efficacy was measured by the Clinical Institute Withdrawal Assessment for alcohol (CIWA-Ar) scores. Lorazepam was used as supplement medication if withdrawal symptoms could not be controlled effectively by the study drugs alone. Both direct and indirect medical costs were considered and the CEA was analyzed in both patient's perspective and third-party perspective.
RESULTS
The average cost-effectiveness ratio (ACER) in patient's perspective of baclofen and chlordiazepoxide was Rs. 5,308.61 and Rs. 2,951.95 per symptom-free day, respectively. The ACER in third-party perspective of baclofen and chlordiazepoxide was Rs. 895.01 and Rs. 476.29 per symptom-free day, respectively. Participants on chlordiazepoxide had more number of symptom-free days when compared with the baclofen group on analysis by Mann-Whitney test (U = 253.50, P = 0.03).
CONCLUSION
Both study drugs provided relief of withdrawal symptoms. Chlordiazepoxide was more cost-effective than baclofen. Baclofen was relatively less effective and more expensive than chlordiazepoxide.
Topics: Adolescent; Adult; Aged; Baclofen; Chlordiazepoxide; Cost-Benefit Analysis; Drug Administration Schedule; Drug Costs; Ethanol; Female; Humans; Male; Middle Aged; Substance Withdrawal Syndrome; Treatment Outcome; Young Adult
PubMed: 25097273
DOI: 10.4103/0253-7613.135947 -
Alcohol and Alcoholism (Oxford,... Jan 2024To address the question of tailored baclofen prescribing in alcohol use disorder (AUD) in relation to dose-dependent efficacy and the potential danger of high doses and... (Review)
Review
AIMS
To address the question of tailored baclofen prescribing in alcohol use disorder (AUD) in relation to dose-dependent efficacy and the potential danger of high doses and to provide suggestions for the use of high doses of baclofen in the treatment of AUD. The context is the approvement in France of baclofen in the treatment of AUD without dose limitation, making French physicians, who usually prescribe baclofen in a tailored manner, often use high or very high doses.
METHODS
A narrative review of the results of randomized controlled trials (RCTs) and observational studies that used tailored baclofen prescribing and of the severe adverse effects of baclofen that have been reported in the literature.
RESULTS
The results show that RCTs using tailored doses of baclofen in AUD are not completely demonstrative, though they are encouraging according to certain meta-analyses, while observational studies that used tailored doses constantly show a good effectiveness of baclofen treatment. The results suggest that many severe adverse effects of baclofen could be related to a nonrespect by physicians of prescription rules and appropriate treatment monitoring.
CONCLUSIONS
The use of tailored doses shows that the dose required to suppress cravings is highly variable, low or high, depending on each case. Analysis of the circumstances in which severe adverse effects occur suggest that a careful monitoring of baclofen prescribing might prevent a large majority of severe adverse effects. We propose that the education of the patients and the prescription skills, seriousness, and availability of the prescribing physicians are of major importance in the managing of tailored baclofen treatment of AUD.
Topics: Humans; Alcoholism; Baclofen; Craving; Drug-Related Side Effects and Adverse Reactions; Educational Status
PubMed: 38266071
DOI: 10.1093/alcalc/agad090 -
Journal of the American Veterinary... Oct 2012To identify dogs and cats with baclofen toxicosis and characterize the patient population, clinical signs, and outcome.
OBJECTIVE
To identify dogs and cats with baclofen toxicosis and characterize the patient population, clinical signs, and outcome.
DESIGN
Retrospective case series.
ANIMALS
140 dogs and 5 cats with baclofen toxicosis.
PROCEDURES
An animal poison control center electronic database was reviewed from November 2004 through April 2010 to identify dogs and cats with baclofen toxicosis. Information on signalment, clinical signs, and amount of baclofen ingested was obtained. Clinical signs were categorized as CNS, gastrointestinal, general malaise, cardiovascular, respiratory, or urogenital. Follow-up communications were performed to determine overall outcome.
RESULTS
Dogs had a median age of 0.67 years (range, 0.1 to 15 years) and cats of 1 year (range, 0.7 to 16 years). Of 145 patients, 133 (92%) developed clinical signs of baclofen toxicosis. A total of 259 signs fell within defined categories: CNS (121/259 [46.7%]), gastrointestinal (69/259 [26.6%]), general malaise (27/259 [10.4%]), cardiovascular (23/259 [8.9%]), respiratory (14/259 [5.4%]), and urogenital (5/259 [1.9%]). For 68 dogs with known survival status, survival rate was 83.8% (57/68); of these dogs, the amount of baclofen ingested was known for 53 (46 survivors and 7 nonsurvivors). Amount of baclofen ingested was significantly lower in survivor dogs (median, 4.2 mg/kg [1.91 mg/lb]; range, 0.61 to 61 mg/kg [0.28 to 27.7 mg/lb]), compared with nonsurvivor dogs (median, 14 mg/kg [6.4 mg/lb]; range, 2.3 to 52.3 mg/kg [1.04 to 23.77 mg/lb]. Of 5 cats, 2 survived, 1 died, and 2 had unknown outcomes.
CONCLUSIONS AND CLINICAL RELEVANCE
Clinical signs of baclofen toxicosis occurred in most patients, with the CNS being the system most commonly affected.
Topics: Animals; Baclofen; Cat Diseases; Cats; Dog Diseases; Dogs; Female; Male; Muscle Relaxants, Central; Poison Control Centers; Retrospective Studies
PubMed: 23039981
DOI: 10.2460/javma.241.8.1059 -
Journal of Investigative Medicine High... 2022Abrupt baclofen withdrawal may be life-threatening with varied neuropsychiatric manifestations. We present a case of baclofen withdrawal necessitating intubation. A...
Abrupt baclofen withdrawal may be life-threatening with varied neuropsychiatric manifestations. We present a case of baclofen withdrawal necessitating intubation. A 58-year-old female with a history of undiagnosed muscle spasticity presented with worsening extremities tremors, paresthesia, and weakness for 2 days. Initial vitals included temperature 103 F, tachycardia, hypertension, and tachypnea. Examination revealed coarse tremors of all extremities. Inflammatory markers, blood, and urine culture were negative. Head and spine imaging were non-diagnostic. Meningitis and seizure were ruled out. She continued worsening with hallucinations, hyperpyrexia, ocular clonus, and profound muscle rigidity. The patient was intubated for respiratory distress and transferred to intensive care unit (ICU). Further history revealed running out of oral baclofen 3 days ago. Baclofen was restarted with symptomatic improvement. The patient was extubated after 2 days and discharged to a rehabilitation facility. Oral or intrathecal baclofen is thought to inhibit spinal nerves reducing muscle spasm and pain. Abrupt stoppage causes activation of dopamine and noradrenergic receptors causing muscle spasms, tremors, hyperpyrexia, delusions, hallucination, and delirium. Severe cases can mimic meningoencephalitis, seizure disorder, or neuroleptic malignant syndrome. Symptoms usually develop in 1 to 3 days of cessation and can be life-threatening if unrecognized timely. Treatment includes supportive therapy, re-administration of baclofen, or use of benzodiazepines, propofol, dexmedetomidine; however, no specific guidelines have been established. To the knowledge of the authors, this is the first case of oral baclofen withdrawal requiring intubation. We found only 3 reported cases of intrathecal baclofen withdrawal necessitating intubation.
Topics: Baclofen; Humans; Middle Aged; Muscle Spasticity; Respiration, Artificial; Seizures; Substance Withdrawal Syndrome
PubMed: 35356848
DOI: 10.1177/23247096211060584 -
Annals of Agricultural and... Dec 2017Baclofen is a drug used mainly to treat muscle spasticity. Its overdose can lead to life-threatening clinical symptoms, including acute respiratory failure requiring...
INTRODUCTION AND OBJECTIVES
Baclofen is a drug used mainly to treat muscle spasticity. Its overdose can lead to life-threatening clinical symptoms, including acute respiratory failure requiring mechanical ventilation. The aim of this study was to assess the prevalence of selected clinical symptoms associated with baclofen poisoning comparing to an ingested dose.
MATERIAL AND METHODS
60 cases of oral baclofen poisoning were analyzed. Gender, age distribution, and correlation between the dose of ingested baclofen were studied, as well as and following clinical parameters: degree of altered consciousness, heart rate, blood pressure, presence of acute respiratory failure, duration of mechanical ventilation, and presence of psychotic symptoms.
RESULTS
The study found statistically significant correlations between dosage of ingested baclofen and presence of acute respiratory failure, as well as duration of mechanical ventilation. No statistically significant correlations were found between the dose of ingested baclofen and presence of hypertension, bradycardia, acute psychotic symptoms, or level of consciousness disturbance. However, it was found that patients who suffered from hypertension, bradycardia, and altered mental status ingested a larger dose of baclofen.
CONCLUSIONS
There is a statistically significant correlation between the dose of ingested baclofen and the presence of acute respiratory failure, and duration of mechanical ventilation. Patients who have taken a single dose of baclofen of 200 mg, or higher, should be managed in centres able to provide continuous monitoring of life functions. Those with a higher level of a single dose of baclofen ingestion (>500 mg), should be hospitalized in a Toxicology Unit or Intensive Care Unit able to provide airway support and mechanical ventilation.
Topics: Adolescent; Adult; Age Factors; Baclofen; Blood Pressure; Dose-Response Relationship, Drug; Female; Heart Rate; Humans; Male; Middle Aged; Muscle Relaxants, Central; Respiratory Insufficiency; Young Adult
PubMed: 29284225
DOI: 10.5604/12321966.1230735 -
Developmental Medicine and Child... Jan 2023To describe the clinical course of pain intensity in individuals with cerebral palsy (CP) resulting from usual care or specific interventions. (Review)
Review
AIM
To describe the clinical course of pain intensity in individuals with cerebral palsy (CP) resulting from usual care or specific interventions.
METHOD
We conducted an exploratory prognostic systematic review searching electronic databases from inception to 31st December 2021. Evidence from low and moderate risk-of-bias studies was synthesized.
RESULTS
We retrieved 2275 citations; 18 studies met the inclusion criteria and 10 were synthesized. The course of pain intensity in children with CP receiving usual care was stable over 15 weeks (χ = 1.8, p = 0.5). Children who received continuous intrathecal baclofen (CITB) reported significant pain intensity reduction (visual analogue scale [VAS] = -4.2 out of 10, 95% confidence interval [CI] = -6.3 to -2.1]) 6 months postinsertion but similar children receiving usual care had no significant change over 6 months (VAS = 1.3 out of 10, 95% CI = -1.3 to 3.6). Children receiving botulinum neurotoxin A (BoNT-A) injections had significant decreases in pain after 1 month (numeric rating scale = -6.5, 95% CI = -8.0 to -5.0). Adults with chronic pain receiving usual care reported stable pain intensity over time; pain intensity improved in ambulatory adults exercising and those treated surgically for cervical myelopathy.
INTERPRETATION
The course of pain intensity in individuals with CP is unclear. Evidence suggests that children and adults receiving usual care had stable pain intensity over the short or long term. Interventions (CITB and BoNT-A in children and exercise and surgical treatment for cervical myelopathy in adults) had pain intensity reduction. Larger study samples are needed to confirm these results.
WHAT THIS PAPER ADDS
Pain intensity was stable in children with cerebral palsy (CP) receiving usual care. Adults with CP and chronic pain receiving usual care had stable, persistent pain intensity. Children receiving continuous intrathecal baclofen via pump and botulinum neurotoxin A reported significantly lower pain intensities. Adults with chronic pain and dyskinetic CP and cervical myelopathy reported significantly lower pain intensity with exercise or cervical decompression. Limited high-quality evidence exists describing non-procedural pain changes in individuals with CP.
Topics: Adult; Child; Humans; Baclofen; Botulinum Toxins, Type A; Cerebral Palsy; Chronic Pain; Pain Measurement; Prognosis; Spinal Cord Diseases
PubMed: 35871758
DOI: 10.1111/dmcn.15358