Cyproheptadine for pediatric intrathecal baclofen withdrawal: a case report
Intrathecal baclofen withdrawal syndrome is a known complication of intrathecal baclofen pumps. Its origin is postulated as an independent form of a serotonergic syndrome occurring from loss of gamma-aminobutyric acid B receptor-mediated inhibition of serotonin. Prodromal symptoms include pruritus,...
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| Veröffentlicht in: | American journal of physical medicine & rehabilitation 2007-12, Vol.86 (12), p.994 |
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| container_title | American journal of physical medicine & rehabilitation |
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| creator | Saveika, Joseph A Shelton, Jean E |
| description | Intrathecal baclofen withdrawal syndrome is a known complication of intrathecal baclofen pumps. Its origin is postulated as an independent form of a serotonergic syndrome occurring from loss of gamma-aminobutyric acid B receptor-mediated inhibition of serotonin. Prodromal symptoms include pruritus, a return of deep tendon reflexes, and increased spastic hypertonia. Previous reports have documented use of cyproheptadine in treatment of this syndrome in adults with positive results. We present the case of a 14-yr-old child with cerebral palsy who developed pruritus and worsening spastic hypertonia 18 mos after pump implantation. She had been previously treated with 520 microg/day of intrathecal baclofen. Progression of her symptoms was successfully arrested by the administration of both oral and intrathecal baclofen and 6 mg of oral cyproheptadine every 6 hrs for 1 day. We postulate that cyproheptadine should be considered a valuable adjuvant therapy for treatment of suspected intrathecal baclofen withdrawal syndrome. |
| doi_str_mv | 10.1097/PHM.0b013e31815b5c58 |
| format | Article |
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Its origin is postulated as an independent form of a serotonergic syndrome occurring from loss of gamma-aminobutyric acid B receptor-mediated inhibition of serotonin. Prodromal symptoms include pruritus, a return of deep tendon reflexes, and increased spastic hypertonia. Previous reports have documented use of cyproheptadine in treatment of this syndrome in adults with positive results. We present the case of a 14-yr-old child with cerebral palsy who developed pruritus and worsening spastic hypertonia 18 mos after pump implantation. She had been previously treated with 520 microg/day of intrathecal baclofen. Progression of her symptoms was successfully arrested by the administration of both oral and intrathecal baclofen and 6 mg of oral cyproheptadine every 6 hrs for 1 day. We postulate that cyproheptadine should be considered a valuable adjuvant therapy for treatment of suspected intrathecal baclofen withdrawal syndrome.</description><identifier>ISSN: 0894-9115</identifier><identifier>DOI: 10.1097/PHM.0b013e31815b5c58</identifier><identifier>PMID: 18090440</identifier><language>eng</language><publisher>United States</publisher><subject>Adolescent ; Age Factors ; Baclofen - administration & dosage ; Baclofen - pharmacology ; Cerebral Palsy - drug therapy ; Child ; Cyproheptadine - therapeutic use ; Equipment Failure ; Female ; GABA Agonists - administration & dosage ; GABA Agonists - pharmacology ; Histamine H1 Antagonists - therapeutic use ; Humans ; Infusion Pumps ; Injections, Spinal - instrumentation ; Pruritus - etiology ; Quadriplegia - drug therapy ; Substance Withdrawal Syndrome - drug therapy</subject><ispartof>American journal of physical medicine & rehabilitation, 2007-12, Vol.86 (12), p.994</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c254t-b3f4bb65edfa2fb8d35ced9bd3de6c6858fda86a0a80a92749aa3fbe970a99b73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18090440$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Saveika, Joseph A</creatorcontrib><creatorcontrib>Shelton, Jean E</creatorcontrib><title>Cyproheptadine for pediatric intrathecal baclofen withdrawal: a case report</title><title>American journal of physical medicine & rehabilitation</title><addtitle>Am J Phys Med Rehabil</addtitle><description>Intrathecal baclofen withdrawal syndrome is a known complication of intrathecal baclofen pumps. 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We postulate that cyproheptadine should be considered a valuable adjuvant therapy for treatment of suspected intrathecal baclofen withdrawal syndrome.</description><subject>Adolescent</subject><subject>Age Factors</subject><subject>Baclofen - administration & dosage</subject><subject>Baclofen - pharmacology</subject><subject>Cerebral Palsy - drug therapy</subject><subject>Child</subject><subject>Cyproheptadine - therapeutic use</subject><subject>Equipment Failure</subject><subject>Female</subject><subject>GABA Agonists - administration & dosage</subject><subject>GABA Agonists - pharmacology</subject><subject>Histamine H1 Antagonists - therapeutic use</subject><subject>Humans</subject><subject>Infusion Pumps</subject><subject>Injections, Spinal - instrumentation</subject><subject>Pruritus - etiology</subject><subject>Quadriplegia - drug therapy</subject><subject>Substance Withdrawal Syndrome - drug therapy</subject><issn>0894-9115</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0MFKAzEQxvEcFFurbyCSF9g6aZLdxJsUbcWKHvS8TJIJXdl2l2yk9O2ttCB4Gubw_w4_xm4ETAXY6u59-ToFB0KSFEZop702Z2wMxqrCCqFH7HIYvgBAW1ldsJEwYEEpGLOX-b5P3Zr6jKHZEo9d4j2FBnNqPG-2OWFek8eWO_RtF2nLd01eh4Q7bO85co8D8UR9l_IVO4_YDnR9uhP2-fT4MV8Wq7fF8_xhVfiZVrlwMirnSk0h4iw6E6T2FKwLMlDpS6NNDGhKBDSAdlYpiyijI1sdXusqOWHquOtTNwyJYt2nZoNpXwuofz3qg0f93-OQ3R6z_tttKPxFJwz5AxDdYU8</recordid><startdate>200712</startdate><enddate>200712</enddate><creator>Saveika, Joseph A</creator><creator>Shelton, Jean E</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>200712</creationdate><title>Cyproheptadine for pediatric intrathecal baclofen withdrawal: a case report</title><author>Saveika, Joseph A ; Shelton, Jean E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c254t-b3f4bb65edfa2fb8d35ced9bd3de6c6858fda86a0a80a92749aa3fbe970a99b73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adolescent</topic><topic>Age Factors</topic><topic>Baclofen - administration & dosage</topic><topic>Baclofen - pharmacology</topic><topic>Cerebral Palsy - drug therapy</topic><topic>Child</topic><topic>Cyproheptadine - therapeutic use</topic><topic>Equipment Failure</topic><topic>Female</topic><topic>GABA Agonists - administration & dosage</topic><topic>GABA Agonists - pharmacology</topic><topic>Histamine H1 Antagonists - therapeutic use</topic><topic>Humans</topic><topic>Infusion Pumps</topic><topic>Injections, Spinal - instrumentation</topic><topic>Pruritus - etiology</topic><topic>Quadriplegia - drug therapy</topic><topic>Substance Withdrawal Syndrome - drug therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Saveika, Joseph A</creatorcontrib><creatorcontrib>Shelton, Jean E</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>American journal of physical medicine & rehabilitation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Saveika, Joseph A</au><au>Shelton, Jean E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cyproheptadine for pediatric intrathecal baclofen withdrawal: a case report</atitle><jtitle>American journal of physical medicine & rehabilitation</jtitle><addtitle>Am J Phys Med Rehabil</addtitle><date>2007-12</date><risdate>2007</risdate><volume>86</volume><issue>12</issue><spage>994</spage><pages>994-</pages><issn>0894-9115</issn><abstract>Intrathecal baclofen withdrawal syndrome is a known complication of intrathecal baclofen pumps. Its origin is postulated as an independent form of a serotonergic syndrome occurring from loss of gamma-aminobutyric acid B receptor-mediated inhibition of serotonin. Prodromal symptoms include pruritus, a return of deep tendon reflexes, and increased spastic hypertonia. Previous reports have documented use of cyproheptadine in treatment of this syndrome in adults with positive results. We present the case of a 14-yr-old child with cerebral palsy who developed pruritus and worsening spastic hypertonia 18 mos after pump implantation. She had been previously treated with 520 microg/day of intrathecal baclofen. Progression of her symptoms was successfully arrested by the administration of both oral and intrathecal baclofen and 6 mg of oral cyproheptadine every 6 hrs for 1 day. 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| fulltext | fulltext |
| identifier | ISSN: 0894-9115 |
| ispartof | American journal of physical medicine & rehabilitation, 2007-12, Vol.86 (12), p.994 |
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| language | eng |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adolescent Age Factors Baclofen - administration & dosage Baclofen - pharmacology Cerebral Palsy - drug therapy Child Cyproheptadine - therapeutic use Equipment Failure Female GABA Agonists - administration & dosage GABA Agonists - pharmacology Histamine H1 Antagonists - therapeutic use Humans Infusion Pumps Injections, Spinal - instrumentation Pruritus - etiology Quadriplegia - drug therapy Substance Withdrawal Syndrome - drug therapy |
| title | Cyproheptadine for pediatric intrathecal baclofen withdrawal: a case report |
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