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Rapidaccurate diagnosis and treatment in an emergency-room or intensive-care setting are important in order to prevent the potentially life-threatening central nervous system and systemic effects of intrathecal baclofen withdrawalThe suggested treatment for intrathecal baclofen withdrawal is the restoration of intrathecal baclofen at or near the same dosage as before therapy was interruptedHoweverif restoration of intrathecal delivery is delayedtreatment with GABA-ergic agonist drugs such as oral or enteral baclofenor oralenteralor intravenous benzodiazepines may prevent potentially fatal sequelaeOral or enteral baclofen alone should not be relied upon to halt the progression of intrathecal baclofen withdrawal.
It is mandatory that the patientall patient caregiversand the physicians responsible for the patient receive adequate information regarding the risks of this mode of treatmentAll medical personnel and caregivers should be instructed in 1the signs and symptoms of overdose2procedures to be followed in the event of overdose and 3proper home care of the pump and insertion site.
Extreme caution must be used when filling an FDA approved implantable pumpSuch pumps should only be refilled through the reservoir refill septumInadvertent injection into the subcutaneous tissue can occur if the reservoir refill septum is not properly accessedSome pumps are also equipped with a catheter access port that allows direct access to the intrathecal catheterDirect injection into this catheter access port or inadvertent injection into the subcutaneous tissue may cause a life-threatening overdose.
The precise mechanism of action of baclofen as a muscle relaxant and antispasticity agent is not fully understoodBaclofen inhibits both monosynaptic and polysynaptic reflexes at the spinal levelpossibly by decreasing excitatory neurotransmitter release from primary afferent terminalsalthough actions at supraspinal sites may also occur and contribute to its clinical effectBaclofen is a structural analog of the inhibitory neurotransmitter gamma-aminobutyric acidGABAand may exert its effects by stimulation of the GABA B receptor subtype.
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lioresal intrathecal therapy may be considered as an alternative to destructive neurosurgical procedures.