Darbari Farzana P, Melvin Joseph J, Piatt Joseph H, Adirim Terry A, Kothare Sanjeev V
Department of Pediatrics, Division of Neurology, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA 19134, USA.
Pediatr Neurol. 2005 Nov;33(5):373-7. doi: 10.1016/j.pediatrneurol.2005.05.017.
Intrathecal baclofen therapy is increasingly used to alleviate medically intractable spasticity in children with cerebral palsy, spinal cord injuries, and generalized dystonia. Complications like overdose or withdrawal can occur and could be the result of pump malfunction (device-related) or refilling and programming mistakes (human errors). This report describes a case, with emphasis on electroencephalographic changes, of a 12-year old male on long-term intrathecal baclofen therapy who had sequential occurrence of both acute inadvertent baclofen overdose followed by withdrawal symptoms. During baclofen intoxication, electroencephalography documented periodic generalized epileptiform discharges, occasionally followed by intermittent electro-decremental responses on a background of diffuse delta slowing (1-2 Hz). During withdrawal, mild generalized slowing during wakefulness was observed along with the appearance of high-amplitude, sharply contoured delta activity resembling frontal intermittent rhythmic delta activity in sleep. To our knowledge, this temporal profile of electroencephalographic features during baclofen intoxication followed by withdrawal has not been described before in pediatric patients. It is important for treating physicians to recognize the evolution of this electroencephalographic pattern in order to avoid misinterpretation of diagnosis and prognosis.
鞘内注射巴氯芬疗法越来越多地用于缓解患有脑瘫、脊髓损伤和全身性肌张力障碍儿童的药物难治性痉挛。可能会出现如用药过量或戒断等并发症，这可能是泵故障（与设备相关）或重新填充及编程错误（人为失误）导致的。本报告描述了一例病例，重点关注脑电图变化，该病例为一名12岁男性，长期接受鞘内注射巴氯芬治疗，先后出现急性意外巴氯芬过量，随后出现戒断症状。在巴氯芬中毒期间，脑电图记录到周期性全身性癫痫样放电，偶尔在弥漫性δ波减慢（1 - 2Hz）背景下伴有间歇性电衰减反应。在戒断期间，观察到清醒时轻度全身性减慢，同时出现高振幅、轮廓清晰的δ波活动，类似于睡眠中的额叶间歇性节律性δ波活动。据我们所知，小儿患者中此前尚未描述过巴氯芬中毒后戒断期间脑电图特征的这种时间变化情况。治疗医生认识到这种脑电图模式的演变很重要，以便避免误诊和误判预后。
