WARNINGS
Abrupt discontinuation of intrathecal baclofen,
regardless of the cause, has resulted in sequelae
that include high fever, altered mental status,
exaggerated rebound spasticity, and muscle rigidity,
that in rare cases has advanced to rhabdomyolysis,
multiple organ-system failure and death.
Prevention of abrupt discontinuation of intrathecal
baclofen requires careful attention to programming
and monitoring of the infusion system, refill scheduling
and procedures, and pump alarms. Patients and caregivers
should be advised of the importance of keeping scheduled
refill visits and should be educated on the early
symptoms of baclofen withdrawal. Special attention
should be given to patients at apparent risk (e.g.
spinal cord injuries at T-6 or above, communication
difficulties, history of withdrawal symptoms from
oral or intrathecal baclofen). When appropriate,
oral baclofen and/or diazepam rectal gel can be
prescribed for emergency use. Consult the technical
manual of the implantable infusion system for additional
postimplant clinician and patient information (see
WARNINGS).
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