Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
Neurocrit Care. 2012 Jun;16(3):428-32. doi: 10.1007/s12028-011-9669-6.
Intrathecal baclofen (ITB) is an effective and well-tolerated treatment for patients with severe spasticity. Intoxications are rare and usually iatrogenic, with reported intrathecal boluses varying between 0.050 and 30 mg.
We here report the case of a 47-year-old woman with severe spastic paraplegia due to multiple sclerosis who, during a routine filling procedure, accidentally received a bolus of 60 mg ITB because of injection into the side-port instead of the reservoir of her ITB pump (Archimedes(®), Codman, Germany).
After a short period of dizziness, she lost consciousness and stopped breathing. She was immediately intubated, mechanically ventilated, and admitted to the intensive care unit. As specific treatment, she received cerebrospinal fluid drainage through a newly implanted lumbar catheter. A series of generalized and complex partial seizures were treated with levetiracetam and lacosamide. Acute autonomic dysfunction with episodic arterial hypo- and hypertensions was controlled by catecholamines and clonidine, respectively. Recurrent hyperthermia, however, responded neither to drugs nor to physical treatment. After 3 weeks, the patient was discharged without any relevant new neurologic signs or symptoms.
This case demonstrates that even excessive doses of ITB can let the patients survive without sequelae if treated promptly and offensively. A pertinent problem during detoxification is the question of when to restart ITB to avoid drug withdrawal.
鞘内注射巴氯芬（ITB）是治疗严重痉挛患者的一种有效且耐受性良好的方法。中毒很少见，通常是医源性的，据报道鞘内推注的巴氯芬剂量在 0.050 至 30 毫克之间不等。
我们在此报告一例 47 岁女性，因多发性硬化症导致严重痉挛性截瘫，在常规填充过程中，由于将药物注入 ITB 泵的侧端口而不是储液器，意外推注了 60 毫克 ITB（Archimedes(®)，Codman，德国）。
短暂头晕后，她失去意识并停止呼吸。她立即被插管、机械通气，并收入重症监护病房。作为特定治疗，她通过新植入的腰椎导管进行了脑脊液引流。一系列全身性和复杂部分性癫痫发作用左乙拉西坦和拉科酰胺治疗。急性自主神经功能障碍伴阵发性动脉低血压和高血压分别用儿茶酚胺和可乐定控制。然而，反复发作的高热对药物和物理治疗均无反应。3 周后，患者出院，无任何相关的新神经体征或症状。
即使是过量的 ITB 剂量，如果及时和积极治疗，患者也可以存活而无后遗症。在解毒过程中一个相关问题是何时重新开始 ITB 以避免药物戒断。
