Abstract
Study design:
Retrospective study based on a revision of the clinical histories of all patients carrying an intrathecal baclofen (ITB) infusion system between July 1988 and March 2007 in a neurorehabilitation hospital.
Objectives:
To describe the psychiatric manifestations due to intoxication or withdrawal of ITB and to explore the possible risk factors for the presentation of delirium secondary to baclofen.
Setting:
Spinal Cord Injury Unit in Barcelona, Spain.
Methods:
We selected patients who presented delirium related to baclofen treatment. We filtered these cases by the search of key words. All the compatible episodes were then reviewed and positive cases were confirmed to perform a descriptive analysis of the different variables. Control subjects were randomly selected for a comparative analysis of the aspects of interest.
Results:
A total of 12 of the 126 patients carrying the intrathecal system in our hospital presented delirium related to baclofen. Eight cases due to intoxication (66.6%) and four due to withdrawal (33.3%) were found. We provide a description of the psychiatric symptoms. There were no fatal cases due to delirium.
Conclusion:
Delirium has a frequency of 9.5% in patients carrying the ITB infusion system, intoxication being more frequent than withdrawal.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Hsieh JC, Penn RD . Intrathecal baclofen in the treatment of adult spasticity. Neurosurg Focus 2006; 21: e5.
Dario A, Tomei G . A benefit-risk assessment of baclofen in severe spinal spasticity. Drug Saf 2004; 27: 799–818.
Penn RD, Kroin JS . Intrathecal baclofen alleviates spinal cord spasticity. Lancet 1984; 1: 1078.
Coffey JR, Cahill D, Steers W, Park TS, Ordia J, Meythaler J et al. Intrathecal baclofen for intractable spasticity of spinal origin: results of a long-term multicenter study. J Neurosurg 1993; 78: 226–232.
Rivas DA, Chancellor MB, Hill K, Freedman MK . Neurological manifestations of baclofen withdrawal. J Urol 1993; 150: 1903–1905.
Coffey RJ, Edgar TS, Francisco GE, Graziani V, Meythaler JM, Ridgely PM et al. Abrupt withdrawal from intrathecal baclofen: recognition and management of a potentially life-threatening syndrome. Arch Phys Med Rehabil 2002; 83: 735–741.
Yassa RY, Iskandar HL . Baclofen-induced psychosis: two cases and a review. J Clin Psychiatry 1988; 49: 318–320.
Harrison SA, Wood Jr CA . Hallucinations after preoperative baclofen discontinuation in spinal cord injury patients. Drug Intell Clin Pharm 1985; 19: 747–749.
Swigar ME, Bowers MB . Baclofen withdrawal and neuropsychiatric symptoms: a case report and review of other case literature. Compr Psychiatry 1986; 27: 396–400.
Turner MR, Gainsborough N . Neuroleptic malignant-like syndrome after abrupt withdrawal of baclofen. J Psychopharmacol 2001; 15: 61–63.
Greenberg MI, Hendrickson RG . Baclofen withdrawal following removal of an intrathecal baclofen pump despite oral baclofen replacement. J Toxicol Clin Toxicol 2003; 41: 83–85.
Green LB, Nelson VS . Death after acute withdrawal of intrathecal baclofen: case report and literature review. Arch Phys Med Rehabil 1999; 80: 1600–1604.
Saltuari L, Marosi MJ, Kofler M, Bauer G . Status epilepticus complicating intrathecal baclofen overdose. Lancet 1992; 339: 373–374.
Roy CW, Wakefield IR . Baclofen pseudopsychosis: case report. Paraplegia 1986; 24: 318–321.
APA. APA. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), 4th edn. text revision 2000.
Michaud L, Bula C, Berney A, Camus V, Voellinger R, Stiefel F et al. Delirium: guidelines for general hospitals. J Psychosom Res 2007; 62: 371–383.
Burns A, Gallagley A, Byrne J . Delirium. J Neurol Neurosurg Psychiatry 2004; 75: 362–367.
Leo RJ, Baer D . Delirium associated with baclofen withdrawal: a review of common presentations and management strategies. Psychosomatics 2005; 46: 503–507.
Leslie DL, Zhang Y, Holford TR, Bogardus ST, Leo-Summers LS, Inouye SK . Premature death associated with delirium at 1-year follow-up. Arch Intern Med 2005; 165: 1657–1662.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Castaño, B., Benito, J., Pires, F. et al. Delirium secondary to intrathecal baclofen. Spinal Cord 47, 477–480 (2009). https://doi.org/10.1038/sc.2008.156
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sc.2008.156