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 mu g/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.