1. 2015;18;E633-E641Intrathecal Baclofen in Spinal Spasticity: Frequency and Severity of Withdrawal Syndrome
   Case Study
   Karel Brabec, MD, Ivana Stetkarova, MD, PhD, Peter Vasko, MD, and Libor Mencl, MD.

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.