Delayed complications of discontinuation of intrathecal baclofen therapy: resurgence of dyssynergic voiding, which triggered off autonomic dysreflexia and hydronephrosis

Spinal Cord
S VaidyanathanP Mansour

Abstract

Case report. To report insidious development of autonomic dysreflexia and hydronephrosis due to dyssynergic voiding following discontinuation of intrathecal baclofen therapy. Regional Spinal Injuries Centre, Southport, UK. A male patient with paraplegia at T-5 (ASIA-A) had implantation of Medtronic Synchromed 8615 s programmable pump to control intractable spasms. After 4 years, the baclofen pump needed replacement because of battery exhaustion. At this time, he was taking oxybutynin 2.5 mg twice a day. He wore a penile sheath and performed intermittent catheterisation three times a day. Intravenous urography showed no dilatation of pelvicalyceal systems or ureters. During the course of the next 4 months, the dose of baclofen had to be increased gradually to 820 microg/day in order to control the spasms. Investigations revealed disconnection of the tube from the pump. The patient decided to undergo explantation of the pump and discontinue intrathecal baclofen therapy altogether. Following removal of the pump, he was prescribed baclofen 20 mg four times a day and diazepam 5 mg twice a day. He continued penile sheath drainage with oxybutynin 2.5 mg twice a day. Although spasms were controlled with oral baclofen and diazepam, he s...Continue Reading

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Citations

Nov 25, 2006·International Urology and Nephrology·H KilicarslanE Y Gultekin
Oct 1, 2009·Neuromodulation : Journal of the International Neuromodulation Society·Adam L SchreiberChristopher S Formal
Dec 16, 2006·International Journal of Clinical Practice. Supplement·D Castro-Diaz, J M Taracena Lafuente
Jul 20, 2016·Neuromodulation : Journal of the International Neuromodulation Society·Michael SaulinoAaron L Boster
Apr 14, 2017·The Journal of Spinal Cord Medicine·Anna Sophia Del FabroGregory Nemunaitis
Nov 22, 2007·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Virginia L GhafoorPamela K Phelps
Jun 21, 2018·The Journal of Spinal Cord Medicine·Ryan Fitzpatrick, Richard Baverstock
Nov 1, 2018·Neuromodulation : Journal of the International Neuromodulation Society·Weston NadhernyAlaa Abd-Elsayed

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