Search

Continuous infusion of intrathecal baclofen (ITB), via implanted pump, is a powerful tool in the management of severe spasticity in neurological disorders. The advantages of ITB therapy are that it is non-destructive, reversible, and programmable, allowing for neuromodulation. Patients reported significant subjective improvements and decreases in muscle tone after baclofen injection, but excessive doses of ITB resulted in motor weakness. Few complications and adverse effects were reported. ITB therapy appears to be a promising treatment to improve residual motor control in patients with severe spasticity.

Objective: Initial outcome of intrathecal baclofen (ITB) treatment in Japan is being reported on., Methods: Chronological change of the Ashworth scale and complications after surgery were analyzed. Data were obtained from 71 children with severe spasticity who had received ITB screening tests by the end of March 2012., Results: Pump implantations for ITB treatment were performed in 43 children out of 62 whose spasticity reduced after baclofen injection at the screening tests. Postoperative evaluations of ITB treatment were carried out within one year and, in some cases, more than 2 years after surgery. Complications related to baclofen were reported on 19 occasions in 12 children within one year of ITB pump implantation, and on 9 occasions in 4 children of the 21 who were followed for more than 2 years. Main complications were hypertonia of muscle, liver dysfunction, and low blood pressure. The frequency of complications was lower than that reported previously. There was no apparent evidence to indicate that complications developed more in children than in adults in this study. The postoperative values of Ashworth scale in the upper and lower extremities were reduced markedly when compared with preoperative levels, and the improvements were statistically significant (P < 0.05)., Conclusions: This is the first report of outcome of ITB for severely disabled children with spasticity in Japan. It was confirmed that ITB for children with severe spasticity is a safe and effective treatment.

Since its introduction in the late 1980s, intrathecal baclofen(ITB) therapy has become the standard treatment for severe generalized spasticity of both spinal and cerebral origin. More than 50,000 pumps were implanted in the world. Long term efficacy of ITB therapy is excellent, although it is frequently associated with complications such as infections, catheter malfunctions, and cerebrospinal fluid leaks. There are some reports of death with withdrawal, overdose and infection. For a good results we need to discuss factors involved in selecting the appropriate treatment modalities for the individual. The treatment of these patients is optimized in the setting of a multidisciplinary team.

A fever of unknown origin developed in a patient with sequelae of acute encephalopathy who had received dantrolene for severe spasticity. A chronic subdural hematoma was found on MRI, and initially it was suspected that the patient had an intracranial infection. However, close investigation ruled out the chronic subdural hematoma as the source of infection. The patient's fever continued in spite of administration of antibiotics and antimycotics. We suspected that the fever was drug-induced and discontinued the use of dantrolene. As a result, the patient's fever promptly went down. After discontinuation of dantrolene the patient experienced increased muscle tone, vomiting and sleep disturbances. Dantrolene was readministered with the consent of the patient's family, but the fever returned. When dantrolene was once again discontinued, the fever immediately went down. We concluded that the fever of the patient was induced by dantrolene.

Here we report a case of eperisone hydrochloride-induced drug eruption. A twenty-three-year-old female suffering from the common cold, headache and arthralgia was administered eperisone hydrochloride with several drugs including loxoprofen sodium. Two hours after receiving the medications, she noticed erythema and edema in the hands, and then the eruption spread across the whole body. The patient was hospitalized and treated with a corticosteroid intravenously. An oral challenge test showed that eperisone hydrochloride was responsible for this drug eruption. There have been eighteen cases of drug eruption caused by eperisone hydrochloride in the literature and eight cases have shown urticaria/anaphylaxis types. Some cases took several hours to exhibit symptoms even for urticaria/anaphylaxis types that were confirmed to induce an immediate allergic reaction.

Chronic unilateral pleural effusion developed in three patients with severe motor and intellectual disabilities. All patients received 5-15 years of dantrolene administration for their spasticity. The cause of pleural effusion was indistinct, despite close investigations for etiologies such as infection or tumor. The pleural fluid consisted of sterile exudate in all patients. One patient had eosinophilia in his pleural fluid, while peripheral blood eosinophilia was seen in the other two. The pleural biopsy and autopsy specimens revealed only non-specific inflammatory findings. After dantrolene therapy was discontinued, pleural effusion almost disappeared in two patients in the following several months, but the other died of multi-organ failure from another underlying disease. It is important to take chemical pleurisy into consideration when dealing with pleural effusion of unknown etiology. Moreover, respiratory side effect should be examined in patients treated with chronic dantrolene administration.