Pruritus after intrathecal baclofen withdrawal: A retrospective study

• Published in: Archives of physical medicine and rehabilitation Vol. 86; no. 3; pp. 494 - 497
• Main Authors: Ben Smail, Djamel, Hugeron, Caroline, Denys, Pierre, Bussel, Bernard
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2005; Elsevier
• Subjects: Animal biology; Baclofen; Baclofen - administration & dosage; Baclofen - adverse effects; Biological and medical sciences; GABA Agonists; GABA Agonists - administration & dosage; GABA Agonists - adverse effects; Humans; Incidence; Infusion Pumps, Implantable; Injections, Spinal; Life Sciences; Medical sciences; Miscellaneous; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Muscle Spasticity; Muscle Spasticity - chemically induced; Muscle Spasticity - epidemiology; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Pruritus; Pruritus - chemically induced; Pruritus - epidemiology; Pruritus - physiopathology; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Rehabilitation; Retrospective Studies; Substance P; Substance P - metabolism; Substance withdrawal symptoms; Substance Withdrawal Syndrome; Substance Withdrawal Syndrome - physiopathology; Veterinary medicine and animal Health; Pruritus; Rehabilitation; Substance withdrawal symptoms; Substance P; Muscle spasticity; Baclofen; Agonist; Skin disease; Multiple sclerosis; Prognosis; Central nervous system; Epidemiology; Inflammatory disease; Incidence; Reeducation; Antispasmodic agent; Segmental; Cohort study; Neurological disorder; Intrathecal; Human; Nervous system diseases; Implant; Pathophysiology; General hospital; Muscle relaxant; Gabaergic agonist; Spasticity; Muscle tonus alteration; Implantation; Concentration; Symptomatology; Striated muscle disease; Central nervous system disease; Frequency; Lesion; Gabaergic receptor B; Daily dose
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2004.09.001

Ben Smail D, Hugeron C, Denys P, Bussel B. Pruritus after intrathecal baclofen withdrawal: a retrospective study. To determine the frequency of pruritus after intrathecal baclofen (ITB) withdrawal and to study the pathophysiology of this symptom. Retrospective cohort study. Rehabilitation department of a general hospital. Patients (N=102) implanted with an ITB pump who had been followed up since 1988. Not applicable. Incidence of pruritus after withdrawal. We studied the relation between pruritus and daily dose, concentration and mode of infusion of baclofen, and cause of the central nervous system lesion inducing spasticity. Pruritus was observed in 10 of 23 cases of ITB withdrawal. It never occurred during the first 3 months after pump implantation. It seems likely that the segmental spinal action of baclofen is responsible for pruritus. There was no statistically significant difference between patients with ITB deprivation who did and did not experience pruritus in their daily infused dosage or in concentration and mode of infusion. Surprisingly, no pruritus was observed in patients with multiple sclerosis. Pruritus is a frequent symptom after ITB withdrawal. Its occurrence is probably subsequent to chronic blocking of the liberation of substance P by baclofen at the spinal level. This symptom is a good clinical predictor of baclofen withdrawal, in contrast to an isolated increase of spasticity that may be due to drug tolerance or irritant factors. Pruritus requires investigation of a possible dysfunction of the infusion system.