1/5. Intrathecal baclofen overdose followed by withdrawal: clinical and EEG features.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.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. Intrathecal baclofen overdose and withdrawal.Intrathecal baclofen (ITB) therapy is being used increasingly to treat medically intractable spasticity in children with cerebral palsy and spinal cord injuries. baclofen overdose and withdrawal are potentially life-threatening complications of pump and spinal catheter system malfunction. We report a case of a 12-year-old boy, on long-term ITB therapy, who presents to our emergency department with an overdose of ITB, which is followed by withdrawal symptoms. The patient initially presented obtunded and in respiratory arrest. His symptoms of respiratory arrest, obtundation, fixed pupils, and hypotension mimicked other diagnoses, such as head trauma. The history obtained from the family about the pump reservoir being refilled just before the onset of symptoms led to the diagnosis. During hospitalization, as the patient recovered from the overdose, he began to experience symptoms of baclofen withdrawal, including hypertension, hyperthermia, and hallucinations. The pump was found to be disconnected and was revised. The patient was discharged home without permanent sequelae. With increased use of ITB, emergency medicine physicians must be aware of the mechanics of these pumps and the management of baclofen toxicity and withdrawal.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. Quadriparesis due to intraspinal cyst after failed posterior occipitocervical fusion in a patient with athetoid cerebral palsy.STUDY DESIGN: A case report and review of the literature are presented. OBJECTIVES: To describe the clinical course and treatment of a patient with athetoid cerebral palsy who had quadriparesis due to an intraspinal cyst, following a failed occipitocervical fusion using sublaminar wires and rods. SUMMARY OF BACKGROUND DATA: Intraspinal cyst as a cause of quadriparesis in a patient with athetoid cerebral palsy is extremely rare. To our knowledge, there have been no publications on this issue. methods: A 60-year-old man with athetoid cerebral palsy and a history of posterior occipitocervical fusion presented with quadriparesis. Salvage surgery for cervical myelopathy and pseudarthrosis was performed with laminectomy and rearthrodesis using the pedicle screw system. An intraspinal cyst was identified as the main cause of the paraparesis. RESULTS: Solid bony fusion and the improvement of paraparesis were achieved 2 years and 1 month after the surgery. He is now able to feed himself and to walk with a cane, both without assistance. CONCLUSION: A physician managing patients with athetoid cerebral palsy should always be aware that an intraspinal cyst in the cervical spine may be the cause of cervical myelopathy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. infant mental health and biological risk.parents seldom seek help directly for infant mental health problems. parents enter the health care system seeking advice for identified or presumed biological problems in their infants. Many of these biological problems, however, have major psychosocial components of importance to infant mental health. It is important that physicians deal directly with the psychosocial issues and avoid converting them into biological medical problems unintentionally. Three common types of problems and appropriate methods of management are discussed to ensure special recognition and effective handling by the physician of psychosocial problems and the promotion of mental health. The problems discussed are the following: Infants seen with defined medical conditions that generally have associated psychosocial problems including child abuse. Infants seen who have fully recovered from critical illnesses but are considered "at risk" for later developmental disability. Infants seen with normal variations of behavior that are misinterpreted by their parents or physicians as due to a medical problem. In infancy medical and psychosocial issues are so closely interwoven that it is critical that physicians learn to recognize the major psychosocial consequences of primary medical problems and the medical manifestations of primary psychosocial problems and their management.- - - - - - - - - - ranking = 4keywords = physician (Clic here for more details about this article) |
5/5. Cerebellar stimulation for cerebral palsy.Eight children with cerebral palsy, who had implanted cerebellar stimulators, were evaluated by a panel of six experienced physicians in a double-blind cross-over experiment with 3-week periods of real and sham stimulation. Neither the panel of physicians nor the patients could tell whether the stimulators were operating or not.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |