1/5. Intrathecal baclofen withdrawal mimicking sepsis.baclofen (Lioresal) is a drug of choice to treat spasticity and is increasingly being administered intrathecally via an implantable pump in cases refractory to oral therapy. Emergency physicians will likely treat patients with baclofen withdrawal or overdose as this treatment becomes more widespread. The syndrome of baclofen withdrawal presents with altered mental status, fever, tachycardia, hypertension or hypotension, seizures, and rebound spasticity, and may be fatal if not treated appropriately. baclofen withdrawal may mimic other diseases including sepsis, meningitis, autonomic dysreflexia, malignant hyperthermia, or neuroleptic malignant syndrome. Treatment consists of supportive care, reinstitution of baclofen, benzodiazepines, and diagnosis and eventual repair of intrathecal pump and catheter malfunction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. pain management with interventional spine therapy in patients with spinal cord injury: a case series.BACKGROUND/OBJECTIVE: chronic pain is common in patients with spinal cord injury (SCI). Any new strategy that is effective in treating this problem would be welcomed by this patient population. methods: A case series is presented of SCI with neuropathic pain. In these 3 cases, interventional spine therapy is used as a diagnostic and/or therapeutic tool in the management of pain. RESULTS: In the cases presented, interventional spine therapy proved useful in identifying the patient's pain generator. In most cases, the intervention was effective in reducing pain for a long enough period to serve as an effective pain management strategy. Other associated problems, such as spasticity, were similarly reduced. CONCLUSION: Interventional spine therapy should be considered as a tool in the armamentarium of any SCI physician managing their patient's chronic pain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. Intrathecal baclofen toxicity and deep coma in minutes.BACKGROUND/OBJECTIVE: In recent years, intrathecal baclofen (ITB) treatment in patients with refractory spasticity has been accepted as an effective therapy. However, this treatment modality may cause life-threatening complications. This report describes the clinical presentation, unfamiliar dilemmas, and treatment of a patient with ITB toxicity and raises awareness of problems that may arise. methods: A 33-year-old man with refractory spasticity due to diffuse white matter injury was admitted for ITB treatment. The patient had respiratory difficulty followed by a generalized seizure and developed coma minutes after the drug administration. The patient was transferred into an intensive care unit immediately and managed accordingly. RESULTS: After proper management, the patient was followed and continued to receive ITB treatment. CONCLUSIONS: ITB therapy is a very effective method of rehabilitation and medication in patients with refractory spasticity, but physicians must be aware of the serious complications that may develop just minutes after the drug is administered. Although safe, baclofen pumps are nevertheless mechanical devices that may malfunction. Therefore, physicians should be mindful of the possibility of life-threatening complications that may develop and lead to a patient's death if proper treatment is not performed.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/5. Self-directed EMG training for the control of pain and spasticity in paraplegia: a case study.A 25-year-old paraplegic woman was able to gain control of her debilitating leg and bladder spasms and abdominal pain using self-directed EMG biofeedback. The case is significant in that she previously had only cursory exposure to biofeedback as an undergraduate student and received only minimal support and direction from an instructor. She proceeded through daily home practice using a borrowed EMG unit and audiotapes from Lester Fehmi's Open Focus series. Records were kept of the frequency and intensity of her pain and spasms, as well as the frequency and procedures of her home practice. She also maintained a record of specific psychosocial events in her life, which, over time, showed a strong, consistent pattern of influence on the recurrence and severity of her symptoms. The woman's physician declared her medical progress remarkable and encouraged her biofeedback work. At 2-year follow-up, she remains virtually symptom- and medication-free. Her successful biofeedback training program provides support for the value of client-directed biofeedback in selected cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. Errors and limitations of the multimodality checking methods of defective spinal intrathecal pump systems. Case report.The loss of benefit from intrathecal baclofen, with increased spasticity and a discrepancy between the residual and the calculated volume content (underinfusion), made us suspect dysfunction of the intrathecal baclofen infusion in a paraplegic patient. Although all possible usual checking methods were used, no failure in the drug administration device (DAD) could be found. Despite some benefit from increasing the daily dose of baclofen, it has not been possible to control the spastic symptoms. Surgery was therefore decided upon, and a small leak at the end of the catheter tip was discovered. Surgeons and physicians should be aware that checking methods of DAD cannot exclude failure of the system. Their errors and limitations are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |