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Central hyperthermia is a very rare disease; however, once it happens, it is associated with a poor prognosis and high mortality for patients with severe brainstem strokes. Following a pontine hemorrhage, a 46-years-old female developed prolonged hyperthermia. Work-ups to the fever gave no significant clues for the origin of fever, and hyperthermia did not respond to any empirical antibiotics or antipyretic agents. The patient's body temperature still fluctuated in a range of 37.5℃ to 39.2℃. Considering the lesion of hemorrhage, we suspected central hyperthermia rather than infectious diseases. We started with baclofen administration at a dose of 30 mg/day. The body temperature changed to a range of 36.6℃ to 38.2℃. We raised the dose of baclofen to 60 mg/day. The patient's body temperature finally dropped to a normal range. Central hyperthermia, caused by failures of thermoregulatory pathways in brainstem, following the pontine hemorrhage rarely occurs. Baclofen can be used to treat suspected central hyperthermia in a patient with pontine hemorrhage.
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Cerebral palsy (CP) was defined as "a permanent, but not unchanging disorder of movement and posture due to a non-progressive defect or lesion of the brain in early life" by the Little Club in 1964. This definition is not universally agreed but it is still widely used. It may be associated with cognitive, sensory and behavioral manifestations.
The prevalence of CP has changed very little over the past 40 years. As a result of improved survival of prematurely born infants with very low birth weight, more individuals have severe motor disability and associated handicaps. The incidence of CP is 2∼5/1,000 live births, but at 7 years of age, the rate is estrmated to be 2/1,000 births.
Management of a child with CP requires a multidisciplinary approach shared with the child and family and should support for them.
Numerous ways have been tried to moderate the abnormalities found in the different varieties of CP. The aim of treatment is to prevent the development of deformity, suppress unwanted or abnormal movements and promote optimal function. The well-known systems of physical therapy include those of the Bobaths, Vojta and the Peto.
Occupational therapy concentrates on eye-hand coordination and upper extremity motor control and other activities of daily life. Orthosis usually is prescribed to correct abnormal posture of the ankle and foot.
Topical injection of phenol, alcohol solution or botulinum toxin into the motor points or motor nerves of a spastic muscle creates a temporary neurolysis and consequent tone reduction lasting 5 to 6 months. Currently intrathecal baclofen is widely used. Where contractures have occurred in the hips and knees, soft tissue surgery around the hip, knee and ankle in a simple operation may be carried out.
Objective: A warfarin-baclofen interaction has been postulated, but has not been documented in the literature. The purpose of this study is to investigate the drug interaction between warfarin and baclofen in rats.
Method: Twenty Sprague-Dawley rats (250-300 gm), divided into a control and a study group were used. 0.02 mg/day of warfarin was administered intraperitoneally without baclofen for the first three days. Daily blood samples were drawn after six hours of warfarin adminstration for measurement of prothrombin time (PT) and International Normalized Ratio (INR). On the fourth day, the rats in the study group were given 0.02 mg of warfarin and 0.6 mg of baclofen intraperitoneally. For the control group, 0.02 mg of warfarin was administered on all four days. PT and INR measurements were taken at 3 hours, 6 hours, and 24 hours after the administration of warfarin with or without baclofen.
Results: Mean INR value was significantly increased by concomitant baclofen administration after 6 hours, resulting in 1.72 for the control group with warfarin alone and 2.74 for the study group with warfarin and baclofen (p＜0.05).
Conclusion: The concomitant administration of warfarin and baclofen affects the anticoagulant effect of warfarin. Physicians should be aware of the risk for increased anticoagulant effect of warfarin when baclofen is also administered.
Objective: To know the effect of intrathecal baclofen on increased muscle tone, spasm and ambulation.
Methods: Six patients with a severe chronic spasticity were evaluated with 10∼75 ㄍg of intrathecal baclofen infusion. Two patient were infused more than two times (25 ㄍg, 50 ㄍg, 75 ㄍg). After each bolus infusion, an assesment was done for the patient's Ashworth score, spasm score, reflex score, peak eccentric torque by Cybex 6000 systemⰒ, H/M ratio, subjective feeling of walking and the gait analysis.
Results: Spasticity decreased from the mean prebolus Ashworth score of 3.4 to mean postbolus Ashworth score of 1.4 and the pre- and postbolus mean reflex score were 3.9 and 1.6 respectively for a minimum of 4 hours. All patients showed that spasms disappeared, and the peak eccentric torque and H/M ratios also decreased. For the bipedal locomotion, all patients improved in their gait speed, step length, and maximal knee flexion angle, but only two patients improved in their subjective ambulatory functions. These two patients could control the spastic limbs voluntarily and walk independently at the prebolus stage. Four patients had more difficulty in gait because of the subjective weakness of extensor muscles of the lower extremities.
Conclusion: Intrathecal baclofen decreased the spasticity, and spasm effectively in patients who had failed the conservative treatment with medication and physical therapy.
Objective: To present two cases of probable warfarin and baclofen interactions which occurred during the concomitant drug administrations.
Case Summary: In the first case, a 55-year-old man with C6 ASIA C receiving 80 mg/day of baclofen was prescribed 5 mg/day of warfarin after heparinization for the treatment of deep vein thrombosis of the left external iliac vein. After the third day of warfarin administration, the patient exhibited cognitive dysfunction. Within one week after initiation of warfarin, the INR increased to 4.4, with increased cognitive dysfunction. After the stop of warfarin, the return of the INR to baseline took six days. In the second case, a 45-year-old man with a spastic right hemiplegia from a stroke and a history of myocardial infarction was on 5 mg/day of warfarin for two years. When forty-five mg of baclofen was added, the patient developed a nausea, fatigue, and confusion after three days. The INR increased to 4.5 at eight days after the baclofen was added, despite the diminished dosage of warfarin.
Conclusion: These two cases suggest a probable warfarin-baclofen interaction. Attention should be given to the patients who concomitantly use the warfarin and baclofen to protect the patient from harmful drug interactions.
Baclofen(B-4-chlorphyl-r-amino butyric acid), a centrally acting gamma amino butyric acid(GABA) agonist is a commonly used pharmaceutics for spasticity of spinal cord lesion. It's effect includes activation of GABA receptor in primary sensory afferent, enhancement of Ranshow cell activity and depression of fusimotor response. It is primarily excreted by glomerullar filtration with a clearance proportional to creatinine clearance. It's popularity is a result of the antispastic effects and the lack of toxic effect on organ. But, transient drowsiness is the most common neurological side effect with therapeutic dose of this drugs. We report here two patients who developed an acute side effects after being treated with relative therapeutic dose of baclofen.
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