An unusual cause of overdose after baclofen pump implantation: Case report

Sean M. Lew, Estee L. Psaty, Rick Abbott

Research output: Contribution to journalArticle

21 Scopus citations

Abstract

OBJECTIVE AND IMPORTANCE: Intrathecal baclofen delivery for the treatment of spasticity has been used for almost 20 years with a great deal of success. A wide variety of complications and pitfalls have been described. This report details a novel complication involving inadvertent and initially unrecognized canalization of the subdural space with the spinal catheter, which ultimately resulted in an overdose. CLINICAL PRESENTATION: An intrathecal pump system was implanted in a 15-year-old girl with spasticity. This initially resulted in a lack of therapeutic effect. The diagnostic workup ultimately led to contrast administration through the pump system, which precipitated a baclofen overdose when sequestered medication in the subdural compartment was released into the intrathecal space. INTERVENTION: The spinal catheter was subsequently revised, and the patient made a full recovery. CONCLUSION: The possibility of a subdural catheter should be included in the differential diagnosis in patients who experience a lack of drug effect after pump implantation, despite increases in dosage. Close monitoring is required because of the risk of spontaneous or induced overdose, which may occur when a communication develops between the subdural and intrathecal compartments.

Original languageEnglish (US)
Number of pages1
JournalNeurosurgery
Volume56
Issue number3
DOIs
Publication statusPublished - Mar 1 2005
Externally publishedYes

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Keywords

  • Baclofen
  • Intrathecal pump
  • Overdose
  • Spasticity
  • Subdural catheter

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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