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SPASTICITY-BACLOFEN

Neurology

SPASTICITY-BACLOFEN

1. Oral GABA-mimetic agent that acts as a GABA agonist at GABA B receptors.

2. Pre-synaptic terminal: decreases Ca 2+ influx & decreases Ach release. Post-synaptic terminal: increases K + egress & increases membrane depolarzation threshold.

3. Careful dose titration period with a usual maximal recommended dose of 20 mg QID.

4. Baclofen may be especially effective in reducing flexor spasms (Shahani & Young 1974; Duncan et al. 1976; Gracies et al. 1997).

5. Adverse events: lowers seizure threshold, drowsiness, insomnia, dizziness, weakness, ataxia, confusion (Hinderer 1990; Gracies et al. 1997; Kirshblum 1999; Burchiel & Hsu 2001).

6. Also, potential for weakness during routine activities and for activity-dependent interventions such as locomotor treadmill training (Roy & Edgerton 2012; Harkema et al. 2012).

7. Increases cough threshold in cervical spinal cord subjects (Dicpinigaitis 2000).

8. Sudden discontinuation or withdrawal of baclofen can result in seizures, confusion, hallucinations and rebound muscle overactivity with fever (Gracies et al. 1997).

9. Tolerance with sustained use of baclofen is possible (Knutsson et al. 1974), but is not a major issue (Roussan et al. 1985; Gracies et al. 1997; Kirshblum 1999).


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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