Intrathecal Baclofen Pump Withdrawal vs Overdose: Ʋuʋudedi, Ʋuʋudedi, kple dzoxɔxɔ si gbɔ eme¶

Baclofen (ITB) pɔmpi si wodo ɖe lãkusi me (abe Medtronic SynchroMed II alo SynchroMed III ɖoɖoa ene) tsɔa baclofen si nye tsi ƒe agbɔsɔsɔme si nye microgram yia ahɔhɔ̃mekawo me tsi (CSF) si ƒo xlã aklãa me tẽ be woatsɔ akpɔ ʋuʋudedi sesẽ si tso ahɔhɔ̃mekawo ƒe dɔmawɔmawɔ nyuie, lãmekawo ƒe ʋuʋu, abi si woxɔ le aklã me, alo abi si dzɔ le ahɔhɔ̃a me dzi. Esi wònye be atikeawo dodo ɖe akɔta me nana atikeawo ƒoa ƒu ɖe aklã ƒe GABA-B xɔlawo dzi zi gbɔ zi 100 wu atikekui siwo womi ta la, pɔmpi ƒe sisi ƒe nutsotso kpata ɖesiaɖe (tso tsidzraɖoƒe ƒuƒlu, ɣeyiɣi si womeɖo be woagade eme o, pɔmpi ƒe rotor si tsi anyi, batri si vɔ, alo aklã me ka si wotsɔ ƒo ƒui/si metso o) ʋãa acute intrathecal catheter withdrawal syndrome le gaƒoƒo 12 va ɖo 48 me. Le go bubu me la, ɖoɖowɔɖi ƒe vodada alo kotoku me atike dodo le lãme na ame le ɣeyiɣi si me wole baclofen gbugbɔ yɔyɔ me ate ŋu ana acute intrathecal baclofen overdose, si ana be lãme nasẽ nadzi ɖe edzi, gbɔgbɔtsixe tsia ame nu, eye wòanɔ alɔ̃ me. Ne dɔnɔ aɖe si wotsɔ baclofen pɔmpi de eme la ƒe ŋutilã bliboa ƒe ʋuʋu kpata si womenya o, lãmekawo ƒe sesẽ sesẽ, dzoxɔxɔ sesẽ, alo alɔ̃dɔdɔ si mesɔ o la, ƒo ka na miaƒe nutoa me tɔwo xexlẽdzesi siwo wozãna kpata enumake. Ne èdi ahɔhɔ̃mekawo kple dzoxɔxɔ ƒe nɔnɔme kpata siwo do ƒome kplii la, kpɔ ɖa serotonin ƒe dɔléle kple ahɔhɔ̃mekawo ƒe dɔléle vɔ̃ɖi, . autonomic dysreflexia le aklã ƒe abixɔxɔ me, kple ayiku ƒe abi kpata kple rhabdomyolysis.

Zi geɖe la, womekpɔa baclofen si woɖena le ʋuka me kpata le dɔwɔƒe siwo kpɔa nudzɔdzɔ kpatawo gbɔ le mɔ gbegblẽ nu be enye dɔlékui ƒe taɖuame, dɔlékuiwutike, ahɔhɔ̃mekawo ƒe dɔléle vɔ̃ɖi, alo autonomic dysreflexia. De dzesi nuxlɔ̃amedzesi si wonya nyuie (intense generalized itching without a rash), toɖoɖo pɔmpia ƒe gbeɖiɖi ƒe ɣlidodo le ememe, nana xɔname baclofen kple benzodiazepines si woano ne dɔnɔa ate ŋu ami nu dedie, kple duƒuƒu yi kɔdzi si ate ŋu abia gbe pɔmpi kpata eye woagbugbɔ akɔta ƒe CSF aɖo te la xɔa amewo ƒe agbe.

Wɔ esia fifia¶

1. Ƒo ka na wò nutoa me xexlẽdzesi kpata enumake. Ƒo ka na 911 le United States kple Canada, 112 le Europa Dukɔwo ƒe Habɔbɔ bliboa me, 999 le United Kingdom, 000 le Australia, alo kpɔ míaƒe nyatakakadzraɖoƒe si nye xexlẽdzesi siwo wozãna kpata. Gblɔ na amesi ɖoe ɖa la eme nakɔ be: "Baclofen pɔmpi si wodo ɖe aɖuɖɔ me ƒe nɔnɔme kpata: wosusu be baclofen ɖeɖeɖa kpata (alo eƒe agbɔsɔsɔme si gbɔ eme) si hiã be woatsɔe ayi kɔdzi enumake."
2. Kpɔe ɖa enumake nenye be dɔnɔa le WITHDRAWAL (rigid, twitching, hot, itching) alo OVERDOSE (limp, sleepy, slow breathing, cold) me.
3. Dzesi siwo fia be woɖea asi le eŋu: Ŋutilã bliboa ƒe ʋuʋudedi sesẽ (pruritus) si me ŋutilã me ʋuʋudedi aɖeke mele o, lãmekawo ƒe ʋuʋu sesĩe kple woƒe sesẽ si le abe ʋuƒo ene, goosebumps, dzi si le du dzi, ʋusɔgbɔdɔ, ʋuʋu alo susumenuwo, kple dzoxɔxɔ si le dzi yim kabakaba (zi geɖe la, ewua Celsius dzidzenu 40 va ɖo 41 [Fahrenheit dzidzenu 104 va ɖo 105.8]).
4. Agbɔsɔsɔme si gbɔ eme ƒe dzesiwo: Alɔ̃dɔdɔ si gbɔ eme (somnolence) ŋgɔyiyi va ɖo coma, floppy "rag-doll" lãmekawo (flaccid hypotonia), lãmeka siwo me goglo ƒe dɔwɔwɔ ƒe bu, nuƒoƒo si me mekɔ o, ʋuʋudedi, gbɔgbɔ blewu si me goglo o (respiratory depression), ʋu ƒe sisi ƒe ɖiɖi, kple dzi ƒe tsotso blewu.
5. Ne dɔnɔa le WITHDRAWAL me eye wòle ŋudzɔ bliboe eye wòte ŋu le nu mimi dedie la, na baclofen xɔname ƒe agbɔsɔsɔme si woŋlɔ na wo kpata (kple diazepam/lorazepam si woŋlɔ nɛ) enumake. Mègana naneke to nu me gbeɖe ne dɔnɔa le alɔ̃ dɔm, le alɔ̃ dɔm vevie, alo le nu mimi ƒe ʋuʋum o. Togbɔ be baclofen si woano ɖeɖe mate ŋu atɔ te ʋumenugbagbeviɣidɔ sesẽwo nono keŋkeŋ o elabena etsoa ʋu kple ahɔhɔ̃ ƒe mɔxenu la blewu akpa, si naa nono ƒe agbɔsɔsɔ gã enumake kpe ɖe benzodiazepine si woŋlɔ na ame ŋu (diazepam alo lorazepam) ƒlea ɣeyiɣi vevi aɖe esime wòle ʋu tsɔm yina kɔdzi.
6. Ne asrã sesẽ le dɔnɔa ŋu eye lãmekawo ƒe ʋuʋu sesẽ (Withdrawal) la, dze gotagome fafa si le dɔ dzi gɔme eye nàkpɔ wo ta tso abixɔxɔ me. Ðe avɔ kpekpewo kple awuwo ɖa, tsɔ tsikpe siwo woxatsa ɖe afɔkpa siwo xɔ dzo me la de kɔ, abɔta, kple akɔta, ŋutigbalẽ si me fesre ƒo tsi le, eye nàtsɔ pad wheelchair alo bed rails ale be myoclonic jerks sesẽwo mahe vɛ o gbagbã alo rhabdomyolysis. Mègaxe mɔ na dɔnɔ si ŋu rebound spasticity sesẽ le le ŋutilã me gbeɖe o, elabena avuwɔwɔ kple mɔxexeɖedɔléle nu nana lãmekawo ƒe gbagbã kple dzoxɔxɔ si gbɔ eme kabakaba.
7. Ne dɔnɔa le DOSE GBƆGBƆ (si le lãmetutudɔ, meʋãna o, alo le gbɔgbɔm blewu) la, do alɔ woƒe yaƒoƒomɔ̃a eye nàdzra ɖo be yeana xɔnamegbɔwo. Mia dɔnɔ si ƒe lãme mekɔ o la ɖe woƒe axadzi le hayahaya ƒe nɔnɔme me be wòaxe mɔ ɖe aɖuɖɔ alo ʋuʋudedi ƒe ʋuʋu nu, ƒo ta blewuu be yaƒoƒomɔ̃a nanɔ ʋuʋu ɖi, eye nàdze xɔname gbɔgbɔ gɔme alo ame tsitsiwo ƒe CPR ne gbɔgbɔ tɔ alo ɖiɖi wu gbɔgbɔ 8 le miniti ɖeka me.
8. Di dɔnɔa ƒe Implanted Device Identification Card eye nàtsɔ dɔnɔa ƒe ɖoɖowɔla si le egodo (ne wode dɔ asi nɛ) ava kɔdzi. Ele be atikewɔla siwo kpɔa nudzɔdzɔ kpatawo gbɔ kple ahɔhɔ̃mekawo nanya pɔmpi ƒe kpɔɖeŋu si tututu (zi geɖe la, Medtronic SynchroMed II alo III si wodo ɖe ƒodo ƒe ŋutigbalẽ te), atike ƒe agbɔsɔsɔme si le tsidzraɖoƒea me (le kpɔɖeŋu me, 500 mcg/mL vs. 2,000 mcg/mL), agbɔsɔsɔme si woazã gbesiagbe, kple ŋkeke si dzi wogbugbɔ kɔe zi mamlɛtɔ.

Nyametsotsoti: intrathecal baclofen pɔmpi kpata ƒe vovototodedeameme¶

flowchart TD
    A["Dɔnɔ si Wotsɔ Baclofen (ITB) Pɔmpi De Aɖuɖɔ Me"] --> B{"Kpɔ lãmekawo ƒe ɖiɖi, ŋudzɔnɔnɔ, kple pɔmpi ƒe ɣlidodo ɖa"}
    B -->|"Ʋuʋudedi si me ʋuʋudedi, ʋuʋudedi sesẽ, dzoxɔxɔ, dzi ƒe tsotso, alo ɣlidodo ƒe ɖiɖi manɔmee"| C["ACUTE ITB WITHDRAWAL SYNDROME (Wometsɔa vi o / Catheter ƒe dɔmawɔmawɔ nyuie) ."]
    C --> D{"Ðe dɔnɔa le ŋudzɔ ŋutɔ eye wòte ŋu mia nu dediea?"}
    D -->|"Ɛ̃"| E["Na xɔnametɔ si woŋlɔ na wò be wòano baclofen + no me/rectal benzodiazepine enumake"]
    D -->|"Ao (alɔ̃dɔdɔ, alɔ̃madɔmadɔ, alo lãmetutudɔ) ."| F["Wɔ NPO dzi pɛpɛpɛ; na benzodiazepine si wotsɔna xɔa ame le dɔgboa me/no me ne woŋlɔe nɛ"]
    E --> G["Fa dɔnɔa vevie kple tsikpe siwo le kɔ/axillae/akɔta eye nàƒo ka na EMS fifia"]
    F --> G
    B -->|"Lãmetsi siwo le ʋuʋum/siwo le ʋuʋum, alɔ̃dɔdɔ vevie, gbɔgbɔ blewu, alo lãmekawo ƒe gbagbã le wo gbugbɔgade lãme na ame megbe"| H["ACUTE ITB OVERDOSE (Kotoku me yɔyɔ, ɖoɖowɔɖi ƒe vodada, alo bolus) ."]
    H --> I["Ʋu yaƒoƒomɔ̃, dae ɖe axadzi mlɔ anyi le hayahaya ƒe nɔnɔme me, lé ŋku ɖe gbɔgbɔ ŋu nyuie"]
    I --> J["Dze xɔname gbɔgbɔwo/CPR gɔme ne gbɔgbɔa le blewu alo tɔ; yɔ EMS enumake"]
    B -->|"Dzoxɔxɔ, vuvu, tsikotoku, alo ʋuʋudedi le ƒodo ƒe pɔmpi alo akɔta ƒe lãɖeɖe dzi"| K["PUMP POCKET DƆLÉLE ALOO CSF HYGROMA: MÈGAÐE ya le aƒeme o; yi ER"]

Alesi intrathecal baclofen system wɔa dɔe kple nusita wòdoa kpo nu¶

Baclofen ƒe ɖoɖo si le lãkusi me nyea akpa eve siwo wodo ɖe lãme:

1. Pɔmpi ƒe disk si woate ŋu awɔ ɖoɖo ɖe eŋu: Tsidzraɖoƒe goglo aɖe si lolo abe hockey-puck ene kple pɔmpi si wotsɔa batri wɔa dɔe (si keke abe sentimeta 3.3 ene eye eƒe titrime anɔ sentimeta 2.8) si wotsɔ amekoko de ƒodo ƒe akpa si le ete ƒe ami si le ŋutigbalẽ te la te. Silicone rababa si te ŋu tsia eɖokui nu reservoir refill septum le pɔmpia titina, eye catheter access port (CAP) sue aɖe le pɔmpia ƒe go kemɛ dzi si kplɔa ame yia aklã ƒe ka la me tẽ toa pɔmpia ƒe mɔ̃a ŋu.
2. The intrathecal catheter: Silicone alo polyurethane tube tsɛ aɖe si te ŋu trɔna bɔbɔe si wotsɔ do ƒome kple pɔmpia ƒe axadzi si toa mɔ to ŋutigbalẽ te ƒo xlã axadzi va ɖoa akɔta ƒe anyime (lumbar spine), gena ɖe aklãa me to dura mater me, eye wòtsɔa ka yia dzi le ahɔhɔ̃mekawo me tsi me (subarachnoid space) yi akɔta alo vidzidɔ ƒe aklã me.

Mɔ̃ɖaŋununya ƒe nusiwo gbɔ catheter ƒe gbagbã tsona zi geɖe (nukatae 70% ƒe kpododonu mezi ɖoɖoe) .¶

Togbɔ be wotrɔ asi le titanium pɔmpi kɔmpiutaa ŋu be wòanɔ anyi ƒe 6.5 va ɖo 7 hafi woate ŋu aɖɔli batri hã la, wotsɔa ŋusẽ akpe geɖe bɔbɔna, trɔa asi le eŋu, eye wòkekea akɔta ƒe ka si te ŋu trɔna bɔbɔe la ɣesiaɣi si dɔnɔa trɔ tso aba dzi yi bunɔkeke me, bɔbɔ ɖe ŋgɔ, alo wòkɔ ɖe edzi le eƒe ƒewuiwo me. Mɔ̃ɖaŋununya ƒe catheter ƒe kuxiwo dometɔ aɖewoe nye:

• Catheter kinking alo occlusion: Sharp bends afisi catheter la dona le pump sutureless connector si le ƒodo dzi alo afisi wòdoa dzogoe to thoracolumbar fascia le akɔta ƒe akpa si le anyime.
• Catheter ƒe gbagbã alo lãɖeɖe: Catheter tubing ƒe nutete le spinous process eve alo lamina ƒuwo dome le akɔta ƒe akpa si le anyime, catheter la gbã ɖe afã me ale be atikewo sina yia paraspinal lãmekawo me (subcutaneous CSF hygroma).
• Catheter dislodgement / migration out of the intrathecal space: Catheter ƒe nugbɔ ƒuna yia megbe doa go to dural doa me yia epidural fat alo subcutaneous tissue me, zi geɖe le kamedede sesẽ, bunɔkeke me gege, spinal fusion dɔwɔwɔ, alo tsitsi ƒe ʋuʋu kpata le ɖevi me megbe.
• Intrathecal catheter-tip granuloma: Macrophages kple abi ƒe lãkusi siwo ƒo xlã catheter ƒe nugbɔ le aklã ƒe mɔ me (ebɔ wu sã le intrathecal morphine alo hydromorphone pɔmpiwo me, gake wogblɔna ɣeaɖewoɣi be baclofen si ƒe agbɔsɔsɔme sɔ gbɔ ɖe eme), si xea mɔ na atikewo ƒe kaka eye wòte ŋu ƒoa aklãa ŋutɔ nu ƒu, si ana afɔ yeyewo nazu lãmetutudɔ alo woƒe lãme nagbã.

Pɔmpi ƒe kotoku me dɔléle, taɖuame, kple akɔta ƒe CSF ƒe sisi ("pseudomeningocele") .¶

Amekoko ƒe teƒea ƒe nɔnɔme kpata eve ate ŋu adzɔ le kwasiɖa 2 va ɖo 8 gbãtɔwo me le pɔmpi dede ame me, batri ɖɔliɖɔli, alo egbugbɔgade to ŋutigbalẽ me megbe:

1. Pɔmpi ƒe kotoku me dɔlékui kple dɔlékui ƒe taɖuame si le dzi yim: Ne abi ƒe ʋuʋu, dzoxɔxɔ, agado ƒe vuvu, tsi si le dodom le abi me, alo abi ƒe ʋuʋu (atike siwo ʋuna be woaɖe titanium ga la afia) va do ɖe ƒodo ƒe pɔmpi ƒe kotoku alo akɔta ƒe akpa si wotso la dzi la, dɔlékui (Staphylococcus aureus alo Staphylococcus epidermidis) ateŋu akplɔ tẽ to catheter tube ƒe gota to dura me ayi ahɔhɔ̃meka me tsi me, si ahe fulminant bacterial meningitis (asrã, kɔ sesẽ, fotovɔvɔ̃, tɔtɔ) vɛ kpe ɖe pɔmpi ƒe gbagbã ŋu. Mègate kpɔ gbeɖe be yeaɖe tsi alo amimie le pɔmpi ƒe kotoku si vuvu me le aƒeme o; yi xɔ si me wokpɔa dɔnɔwo gbɔ le kpata me enumake hena ʋu ƒe dekɔnuwo, CSF dodokpɔ, kple vancomycin si wodona ɖe ʋuka me kpe ɖe cefepime/ceftriaxone ŋu.
2. Lumbar CSF leak and subcutaneous hygroma: Ne ahɔhɔ̃mekawo me tsi do go ƒo xlã dural puncture teƒe le akɔta ƒe akpa si le ete la, ate ŋu ana tsi falɛfalɛ si woate ŋu ada akɔ la nado le megbe ŋutigbalẽ te (pseudomeningocele) eye wòhea classic post-dural puncture headache (taɖuame sesẽ si nu sẽna ɖe edzi ŋutɔ ne èbɔbɔ nɔ anyi ɖe tsitrenu eye wònyona ɖe edzi le aɖabaƒoƒo ʋɛ aɖewo me tso esime mlɔ anyi keŋkeŋ, si kpe ɖe eŋu kple ʋuʋudedi kple kɔ ƒe sesẽ).

Ŋusẽ si le baclofen si wodona ɖe ʋuka me kple esi wodona ɖe nu me dome 100 va ɖo 1¶

Baclofen nye gamma-aminobutyric acid (GABA), si nye amegbetɔ ƒe titina lãmekawo ƒe ahɔhɔ̃mekawo ƒe dɔwɔwɔ ƒe mɔxenu vevitɔ ƒe wɔwɔme ƒe kpɔɖeŋu. Ebla ɖe presynaptic kple postsynaptic GABA-B receptors ŋu tiatiatɔe le aklã ƒe megbedzo me, si xea mɔ na calcium ƒe gege ɖe lãme eye wòdzudzɔa ahɔhɔ̃meka siwo doa dzidzɔ na ame (glutamate kple aspartate) siwo ʋãa lãmeka siwo me ʋu sina tona la ƒe dodo.

Ne dɔnɔ aɖe mi baclofen ƒe atikekui siwo woano (zi geɖe la, miligram 40 va ɖo 80 [microgram 40,000 va ɖo 80,000] gbesiagbe) la, atike la mexɔa ʋu nyuie le ʋu kple ahɔhɔ̃ ƒe mɔxenu la me o, si wɔnɛ be akɔta ƒe CSF ƒe agbɔsɔsɔ sue aɖe si mede nanogram 12 va ɖo 95 le mililita ɖeka me o esime wònana ahɔhɔ̃a me tsina sesĩe. To vovo na ema la, pɔmpi si wotsɔ dea aɖuɖɔ me si dea microgram 300 va ɖo 800 ko gbesiagbe ɖe CSF me tẽ la naa akɔta ƒe agbɔsɔsɔme si sɔ gbɔ wu zi gbɔ zi ene va ɖo ewo wu agbɔsɔsɔ si wozãna le nu me esime wòzãa miligram agbɔsɔsɔme bliboa ƒe akpa 1/100.

Esi wònye be woklɔa aklã ƒe mɔxenu GABA-B xɔlawo ɣesiaɣi le baclofen si me wode nu me gaƒoƒo 24 gbesiagbe ta la, aklã ƒe ahɔhɔ̃mekawo trɔna ɖe nɔnɔmewo ŋu to woawo ŋutɔ ƒe GABA-B xɔlawo ɖiɖi (wo ɖeɖe ɖa) kple dzidzɔdonamenuwo ƒe seselelãme dzi ɖeɖe kpɔtɔ me.

Nusi dzɔna le aklã ƒe ka me ne pɔmpi ƒe sisi tɔ¶

Baclofen ƒe agbenɔƒe afã si le amegbetɔ ƒe ahɔhɔ̃mekawo me nye gaƒoƒo 1.5 va ɖo 5 ko. Ne pɔmpia ƒu alo ka si me pɔmpia le la ƒo alo wòtso:

• Le gaƒoƒo 4 va ɖo 8 me la, CSF baclofen ƒe agbɔsɔsɔ dzi ɖena kpɔtɔna ŋutɔ va ɖoa zero.
• Esi GABA-B ƒe mɔxexeɖedɔléle nu megale eŋu o eye xɔla ƒe kpekpeme si sɔ mele wo si o ta la, aklã ƒe alpha kple gamma motor ahɔhɔ̃mekawo, veveseseɖeamenu ƒe preganglionic ahɔhɔ̃mekawo, kple pruriceptive (itch) interneurons dona le fuléle si me tsitretsiɖeŋu mele o, si yia edzi me.
• Ƒumeŋuɖui ƒe lãmeka ɖesiaɖe si le akɔta kple eƒe nugbɔwo la tsia tetanic ƒe ʋuʋu me, si wɔnɛ be lãmenugbagbeviwo ƒe dzoxɔxɔ gã aɖe dona (thermogenesis over 41 degrees Celsius [105.8 degrees Fahrenheit]) eye wòvuvua lãmekawo me (rhabdomyolysis), evɔ veveseseɖeamenu ƒe lãmekawo ya tsɔa norepinephrine kple... epinephrine (ahom si le eɖokui si).

De dzesi afɔɖeɖe ene siwo me woɖea baclofen le ʋuka me le¶

Baclofen ɖeɖeɖa le lãkusi me zɔna ɖe ɣeyiɣi si woate ŋu agblɔ ɖi, si le dzidzim ɖe edzi kabakaba dzi. De dzesi Afɔɖeɖe 1 hafi asrã kple ŋutinuwo ƒe dɔmawɔmawɔ nyuie nadze egɔme le vevie ŋutɔ.

Afɔɖeɖe 1: Prodrome kaba (gaƒoƒo 6 va ɖo 18 le sisi ƒe nutsotso megbe) .¶

• Aɖuɖɔtoe sesẽ, si bɔ ɖe afisiafi (neuropathic pruritus) MANƆMEŊLƆÐI, aɖuɖɔtoe, alo dzodzro aɖeke si woate ŋu akpɔ o: Esiae nye dzesi ɖeka kolia si koŋ ɖea baclofen ɖeɖeɖa le dɔgboa me ƒe dzesi gbãtɔ koŋ, si dzɔna le dɔnɔ 40 va ɖo 70 le alafa me me elabena zi geɖe la, aklã me GABA-B xɔlawo xea mɔ na akɔta-dzo ƒe ʋuʋu ƒe mɔwo (GRP/Bhlhb5 interneurons). Zi geɖe la, ƒomewo kple ɖɔkta siwo kpɔa dɔnɔwo gbɔ kpata bua esia vodadatɔe be enye nulɔdɔ eye wonaa atike siwo wua ʋumenugbagbeviɣidɔ (diphenhydramine), siwo mewɔa naneke o eye le nyateƒe me la, wogagblẽa nu le alɔ̃madɔmadɔ ŋu.
• Dɔnɔa ƒe afɔwo, abɔwo, alo akɔta ƒe ʋuʋu le gɔmedzedzea me ƒe tɔtrɔgbɔ: Dɔnɔa ƒe afɔwo, abɔwo, alo akɔta sena le eɖokui me be esẽna wu ne ele etsɔm yi teƒe bubu alo le edom, si kpe ɖe eŋu kple dzidziƒoame ƒe ʋuʋu enuenu, afɔkpodzi ƒe ʋuʋu (afɔ ƒoƒo le ɣeyiɣi si sɔ me), kple dzimaɖitsitsi alo alɔ̃madɔmadɔ si meɖea dzi ɖi o.
• Dysesthesia kple paresthesia: Tingling, dzobibi, alo "pins and needles" ƒe seselelãmewo le ŋutigbalẽa katã dzi, fifia (diaphoresis), kple goosebumps ( .piloerection).

Afɔɖeɖe 2: Acute rebound spasticity kple autonomic ahom (gaƒoƒo 18 va ɖo 36) .¶

• Ŋusẽ, vevesese, lãmekawo ƒe ʋuʋu kple sesẽ atraɖii: Opisthotonus sesẽ (akɔta kple kɔ ƒe akɔta), klo kple akɔta ƒe ʋuʋu, kple eƒe nugbɔwo ƒe ʋuʋu atraɖii si nye myoclonic.
• Hyperadrenergic autonomic instability: Dzi ƒe tsotso le gbɔɖemeɣi ƒe duƒuƒu le 120 kple 170 ƒe ƒoƒo le miniti ɖeka me, ʋu ƒe sisi ƒe tɔtrɔ le gbe me (ʋusɔgbɔdɔ sesẽ si trɔna kple ʋusɔgbɔdɔ), gbɔgbɔ kabakaba (tachypnea), kple fifia siwo le tsia ƒom.
• Escalating core fever: Ŋutilã ƒe dzoxɔxɔ dzina ɖe edzi wu 38.5 va ɖo 40.0 degree Celsius (101.3 va ɖo 104.0 degrees Fahrenheit) - si ƒumeŋuɖui ƒe lãmekawo ƒe tete madzudzɔmadzudzɔe kple hypothalamic dysregulation ʋãnɛ keŋkeŋ, ke menye dɔlékui o.
• Tagbɔdɔ kple susu ƒe tɔtrɔ: Tɔtɔ sesẽ, paranoia, nukpɔkpɔ kple nusese ƒe susumenuwo, susu ƒe tɔtɔ, kple delirium.

Afɔɖeɖe 3: Fulminant hyperthermia, status epilepticus, kple rhabdomyolysis (gaƒoƒo 36 va ɖo 72) .¶

• Pyrexia si gbɔ eme: Dzoxɔxɔ vevitɔ wu 40.5 va ɖo 42.0 degree Celsius (104.9 va ɖo 107.6 degrees Fahrenheit), si gblẽa lãmenugbagbeviwo ƒe enzyme siwo le ahɔhɔ̃, aklã, kple dzi me la ƒe nɔnɔme.
• Generalized tonic-clonic seizures and refractory status epilepticus: Cortical GABA-B ƒe asiɖeɖe le eŋu hea alɔ̃madɔmadɔ si yia edzi si medzudzɔna ne womedo atike geɖe ɖe ʋuka me benzodiazepines, propofol, alo barbiturates o.
• Rhabdomyolysis gã kple "Coca-Cola" aɖuɖɔ doviviti: Lãmetsi ƒe gbagbã ɖea creatine kinase (CK ƒe agbɔsɔsɔ si wua 10,000 va ɖo 100,000 U/L zi geɖe), myoglobin, potassium, kple phosphate ƒe agbɔsɔsɔ gã aɖe ɖe ʋua me, si xea ayiku ƒe ʋukawo eye wòhea agbe ƒe afɔku vɛ dzitodzito ƒe dɔmawɔmawɔ nyuie si me hyperkalemic le.

Afɔɖeɖe 4: Lãmenugbagbevi geɖe ƒe dɔmawɔmawɔ nyuie kple dzitodzitowo ƒe gbagbã¶

• Disseminated Intravascular Coagulation (DIC): Ʋu ƒe sisi le ɖoɖo nu si dzi womeɖu o kple ʋu si dona le eɖokui si tso aɖuwo, IV teƒewo, kple dɔgboa me.
• Aklã ƒe dɔmawɔmawɔ nyuie, ayiku ƒe abi kpata, ARDS, kple dzitodzito ƒe ʋuʋu.

Medtronic SynchroMed pɔmpi ƒe ɣlidodo siwo wose gɔmesese¶

Piezoelectric acoustic transducer aɖe le Medtronic SynchroMed II kple III pɔmpi siwo wodo ɖe lãme na ame si naa gbeɖiɖi vovovo siwo woate ŋu ase ne ètsi tre ɖe dɔnɔa gbɔ alo tsɔ wò to ɖo woƒe ƒodo gbɔ:

Vovototo dede ITB ɖeɖeɖa kple nɔnɔme kpata siwo ɖi wo nɔewo dome¶

Esi wònye be dɔnɔ siwo ŋu ahɔhɔ̃mekawo ƒe dɔmawɔmawɔ nyuie, aklã ƒe abi, alo lãmekawo ƒe ʋuʋu le hã te ŋu xɔa aɖuɖɔtoe me dɔlékuiwo, ventriculoperitoneal (VP) shunt dɔlékuiwo, autonomic dysreflexia, kple atikewo ƒe dɔwɔwɔ ɖe ame dzi bɔbɔe ta la, atikewɔla siwo kpɔa nudzɔdzɔ kpatawo gbɔ zãa dɔdamɔnu siwo gbɔna tsɔ dea vovototo baclofen zazã kpata me:

Acute intrathecal baclofen overdose: "kotoku me yɔyɔ" kple ɖoɖowɔɖi ƒe vodadawo¶

Togbɔ be mebɔ wu asiɖeɖe le eŋu o hã la, acute intrathecal baclofen overdose nye yaƒoƒomɔ̃ kple gbɔgbɔtsixetsixe ƒe nɔnɔme kpata. Agbɔsɔsɔme si gbɔ eme dzɔna le nɔnɔme vevi eve me:

1. Accidental Subcutaneous "Pocket Fill" le pɔmpi si wogbugbɔ dea pɔmpi me edziedzi me (Afɔku wu): Ne atikewɔla gade pɔmpia me ɣleti 2 va ɖo 6 ɖesiaɖe la, wotsɔa aŋe toa ƒodo ƒe ŋutigbalẽ me dea titina silicone septum me tsɔ doa baclofen si me wode nu me (si ate ŋu anye 10,000 va ɖo 40,000 microgram ƒe atike le 20-mL me syringe - vaseɖe zi gbɔ zi 50 le agbɔsɔsɔ si wua ame si wodona ɖe ʋuka me). Ne aŋea ƒu alo to ʋukaa me vie gɔ̃ hã la, wodoa agbɔsɔsɔ gã ma ƒe akpa aɖe ɖe amikotoku si le ŋutigbalẽ te si ƒo xlã pɔmpia me tẽ. Le aɖabaƒoƒo 30 va ɖo gaƒoƒo 4 siwo kplɔe ɖo me la, baclofen si me wode nu me la gena ɖe ʋuka siwo me ʋu sina tona me kabakaba, si wɔnɛ be wozãnɛ wògbɔa eme kpata si ate ŋu ade ame ƒe agbe afɔku me (ekplɔe ɖo le ŋkeke siwo tsi tre ɖe wo nɔewo ŋu megbe be eɖe asi le eŋu vevie elabena wogblẽ pɔmpia ƒe tsidzraɖoƒea ŋutɔ ɖi ƒuƒlu).
2. Programming alo concentration-mismatch error: Programming na 2,000 mcg/mL refill concentration abe ɖe wònye 500 mcg/mL ene, alo akɔntabubu vodadatɔe le catheter priming bolus ŋu le amekoko ƒe asitɔtrɔ megbe.

Baclofen zazã fũ akpa ƒe dzesiwo (rostral progression si yia dzi) .¶

Esi baclofen si sɔ gbɔ ɖe edzi le kakam ɖe dzi (rostrally) tso akɔta ƒe CSF dzi va ɖo ahɔhɔ̃meka kple ahɔhɔ̃mekawo dzi:

• Aɖabaƒoƒo 30 va ɖo 90 gbãtɔwo: Afɔ kple akɔta ƒe lãmekawo katã ƒe bu kpata (profound flaccidity / hypotonia), taɖuame, taɖuame, ʋuʋudedi, kple aɖuɖɔtoe si gbɔ eme (sialorrhea).
• Gaƒoƒo 1 va ɖo 4: Alɔ̃dɔdɔ si gbɔ eme (somnolence), nuƒoƒo si me mekɔ o ( .dysarthria), ataxia, dzoxɔxɔ si nu sẽ, dzi ƒe tsotso blewu (bradycardia), kple ʋusɔgbɔdɔ (hypotension).
• Aɖi sesẽ: coma si me goglo si womate ŋu anyɔ o, ŋkume ƒe kekeli ƒe dɔwɔwɔ kple ŋkume ƒe ŋkume ƒe ʋuʋu ƒe bu (si srɔ̃a ahɔhɔ̃ ƒe ku), alɔ̃madɔmadɔ si bɔ (si to vovo tso presynaptic GABA-B autoreceptor disinhibition le cortex me gbɔ), kple gbɔgbɔtsixe / gbɔgbɔtsixetsixe.

Baclofen ƒe agbɔsɔsɔ si gbɔ eme dzi kpɔkpɔ kpata¶

1. Yagbɔgbɔ kple gbɔgbɔe nye gbãtɔ: dɔlékuiwutike tɔxɛ aɖeke meli si dzi woate ŋu aka ɖo bliboe o na baclofen ƒe agbɔsɔsɔ fũ o (wote physostigmine kpɔ le ŋutinya me kple emetsonu siwo mewɔ ɖeka o kple cholinergic ƒe nugbegblẽ le ame ŋu siwo me afɔku le abe bradycardia, bronchospasm, kple alɔ̃madɔmadɔ; flumazenil metrɔa GABA-B xɔlawo o). Gake ne wodo bag-mask yaƒoƒo kple endotracheal intubation kaba la, agbetsitsi tso baclofen zazã fũu akpa gɔ̃ hã me gogoa alafa memama 100 ne atike la nya kɔ le gaƒoƒo 24 va ɖo 72 me ko.
2. Kɔdzi ƒe pɔmpi ƒe nutsitsi kpata kple CSF ƒe tsiɖeɖe: Le xɔ si me wowɔa dɔ kpata le me la, atikewɔlawo biaa gbe pɔmpia enumake be tɔ te atike si wodona ɖe eme (alo woaɖoe ɖe agbɔsɔsɔ suetɔ dzi), woaɖe atike la ɖa le pɔmpia ƒe tsidzraɖoƒea (eye woaɖe tsi ɖesiaɖe si woƒo ƒu ɖe ŋutigbalẽ te kotokua me ne kotoku me yɔ fũ), eye woawɔ akɔta ƒe dodo (alo woaɖee to pɔmpia me axadzi Catheter Access Port) be woaɖe ahɔhɔ̃metsi si me baclofen le 30 va ɖo 40 mL (ɣeaɖewoɣi la, wotsɔa dze si sɔ si me dɔlékuiwutike aɖeke mele o ɖɔliae).

Alesi kɔdziwo wɔa nu ɖe ITB ƒe asiɖeɖe le eŋu kpata ŋu ne èva ɖo¶

Nusi wòle be dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ nawɔ nyanya kpena ɖe dɔnɔdzikpɔlawo ŋu be woʋlia dɔnɔ aɖe ta eme nakɔ ne wova ɖo nutoa me kɔdzi si me ƒã hafi dɔwɔlawo akpɔ pɔmpi siwo wotsɔ dea dɔgboa me le:

1. GABA-A kple GABA-B ƒe ʋuka me agbɔsɔsɔ gã si wodona enumake:
2. Esi wònye be baclofen si woano mate ŋu aɖo aklãa gbɔ kabakaba le eɖeɖeɖa sesẽ me o ta la, atikewɔla siwo kpɔa nudzɔdzɔ kpatawo gbɔ naa benzodiazepines (lorazepam alo diazepam IV boluses kple infusions atraɖii), siwo naa GABA-A receptors wɔa dɔ le anyigba le aklã kple ahɔhɔ̃ me, toa GABA-B mɔ ƒuƒlu la ŋu be wòatɔ te alɔ̃madɔmadɔ, aɖe tetanic lãmekawo ƒe ʋuʋu dzi akpɔtɔ, eye wòatɔ te dzoxɔxɔ si gbɔ eme.
3. Ne dɔnɔa ate ŋu ano atikewo to nu me, nasogastric tube, alo gastrostomy (PEG) tube dzi kokoko la, wodzea enteral baclofen ƒe agbɔsɔsɔ gã (zi geɖe la, 10 va ɖo 20 mg le gaƒoƒo 4 va ɖo 6 ɖesiaɖe me) gɔme le ɣeyiɣi ɖeka me, eye zi geɖe la, wotsɔa cyproheptadine si woano (4 va ɖo 8 mg le gaƒoƒo 6 va ɖo 8 ɖesiaɖe me, si nye serotonin antagonist si naa dɔlékuiwutikea ʋuʋudedi kple myoclonus le baclofen ɖeɖeɖa me) alo dexmedetomidine / propofol dodo le dɔnɔdzikpɔƒe si wokpɔa dɔnɔwo gbɔ vevie.
4. Dantrolene sodium (IV) ateŋu anye kpeɖeŋutɔ na ƒumeŋuɖui ƒe lãmekawo ƒe sesẽ si dea ame ƒe agbe afɔku me vevie kple dzoxɔxɔ si gbɔ eme ne benzodiazepines mesɔ gbɔ o, togbɔ be GABAergic gbugbɔgaɖoanyi gakpɔtɔ nye atike vevitɔ hã.
5. Baclofen dodo ɖe ʋuka me ƒe gbugbɔgaɖo kpata:
6. Ne ɖeko pɔmpia ƒe tsidzraɖoƒe ƒuƒlu alo tsi anyi le MRI wɔwɔ vɔ megbe: Ahɔhɔ̃ŋutinunyala, lãmesẽdɔwɔla (PM&R eŋutinunyala), alo ewɔla si wona hehee ƒe dɔdamɔnu ŋuti nunyala bia gbe pɔmpia kple telemetry-ti la eye wòwɔa abadzidɔ si me dɔlékui mele o ƒe tsidzraɖoƒe gbugbɔgade alo gbugbɔa mɔ̃a dzea egɔme.
7. Ne catheter la ƒo, woɖee, alo gbã eye amekokoa tsi megbe: Ðɔkta ate ŋu awɔ abadzivɔ single-shot lumbar puncture injection of preservative-free intrathecal baclofen (zi geɖe la, 50 va ɖo 100 micrograms) alo atsɔ ɣeyiɣi kpui aɖe ƒe gota akɔta intrathecal catheter ade eme be wòalé fulminant withdrawal enumake vaseɖe amekoko ƒe catheter ɖɔliɖɔli.
8. Tsi dodo ɖe ʋuka me dzikutɔe hena rhabdomyolysis: Isotonic tsi siwo wodona ɖe ʋuka me (0.9% normal saline) wodoa wo ɖe lãme kabakaba be woalé aɖuɖɔ geɖe ɖe te eye woaɖe myoglobin ɖa le ayikuawo me, esime wole ŋku lém ɖe serum potassium, creatine kinase (CK), kple coagulation panels ŋu gaƒoƒo 4 va ɖo 6 ɖesiaɖe.

Nutome ƒe xexlẽdzesi siwo ku ɖe nudzɔdzɔ kpatawo ŋu kple dɔwɔƒea ƒe ɖoɖowo¶

• United States kple Canada: Ƒo ka na 911. United States ƒe Nuɖuɖu Kple Atike Ŋuti Dɔwɔƒe (FDA) ƒe Black Box Nuxlɔ̃ame na baclofen si wodona ɖe aɖuɖɔ me (Lioresal Intrathecal / . Gablofen) de se be woaxɔ ame ɖe kɔdzi kpata ne wosusu be eɖe asi le eŋu, eye wòte gbe ɖe edzi be baclofen si woano ɖeɖe mate ŋu axe mɔ ɖe ŋgɔyiyi si ava zu rhabdomyolysis, ŋutinu geɖe ƒe dɔmawɔmawɔ nyuie, kple ku nu kakaɖedzitɔe o. Atikewɔlawo ateŋu aƒo ka na Medtronic Technical Services Emergency Line si wɔa dɔ gaƒoƒo 24 (1-800-707-0933 le U.S.) hã be woatsɔ ɖoɖowɔɖi ƒe tablɛt axa na nutoa me dɔdaƒe ƒe mɔ̃ɖaŋudɔwɔla si tsɔa ɖoɖowɔɖi ƒe tablɛt yi dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ.
• United Kingdom: Ƒo ka na 999. NHS England Clinical Commissioning Policies for Intrathecal Baclofen Therapy and NICE Spasticity Guidelines fia mɔ be woatsɔe ayi nutome ahɔhɔ̃ŋutinunya alo aklã ƒe abixɔƒe, IV benzodiazepine titration, kple pɔmpi ƒe gbebiame kpata.
• Europa Dukɔwo ƒe Habɔbɔ: Ƒo ka na 112. Europa Ahɔhɔ̃ŋutinunyalawo ƒe Suku (EAN) kple Europa Atikewɔlawo ƒe Dɔwɔƒe (EMA) ƒe ɖoɖowo te gbe ɖe benzodiazepines siwo wozãna le ʋuka me ƒe agbɔsɔsɔ gã, gotagome fafa si le dɔ wɔm, kple xɔname ƒe bolus siwo wozãna kpata le aɖuɖɔtoe me to akɔta ƒe dodo dzi ne pɔmpi ƒe ka ƒe kpododonu na woɖe asi le eŋu vevie dzi.
• Australia kple New Zealand: Ƒo ka na 000 le Australia alo 111 le New Zealand. Atikewɔwɔ ƒe Adzɔnuwo Dzikpɔƒe (TGA) kple ANZCA ahɔhɔ̃mekawo ƒe dɔwɔwɔ ƒe dedienɔnɔ ŋuti nuxlɔ̃amewo bia be woada kɔdzi kpɔ enumake ne pɔmpi ƒe ɣlidodo ɖesiaɖe si ƒe gbeɖiɖi le eve alo ʋuʋudedi/ʋuʋudedi si womeɖe o.
• India kple Asia-Pacific: Ƒo ka na 112 le India, 995 le Singapore, 119 le Japan kple South Korea, alo 999 le Malaysia kple Hong Kong. Le dukɔ bubuwo gome la, kpɔ míaƒe nyatakakadzraɖoƒe si nye dukɔwo dome xexlẽdzesi siwo ku ɖe nudzɔdzɔ kpatawo ŋu.

Nya siwo wobiaa amewo enuenu¶

Nukatae baclofen ƒe asiɖeɖe le ʋuka me nana ŋutilã bliboa ʋuʋuna vevie eye ʋuʋudedi aɖeke menɔa eŋu o?¶

Le amegbetɔ ƒe aklã ƒe megbedzo me la, ahɔhɔ̃meka tɔxɛ siwo xea mɔ na dɔlékuiwo zãa GABA-B xɔlawo tsɔ naa lãmeka siwo naa ʋuʋudedi ƒe dzesiwo nɔa anyi kpoo le nɔnɔme siwo sɔ me. Ne dɔnɔ aɖe xɔ baclofen si le dɔgboa me atraɖii ɣleti alo ƒe geɖe eye kasia eƒe sisi nu tso la, wogblẽa aklã me GABA-B xɔla mawo ɖi womeʋãa wo kura o, si wɔnɛ be aklã ƒe ʋuʋudedi ƒe ahɔhɔ̃mekawo doa dzo le wo ɖokui si eye womeɖea dzi ɖi o. Esi wònye be ʋuʋudedi sia dzɔna tso aklã me tsɔ wu be wòatso histamine ƒe dodo le ŋutigbalẽa me ta la, aɖuɖɔtoe alo abi aɖeke menɔa ŋutigbalẽa me o, eye atike siwo wua histamine abe diphenhydramine (Benadryl) ene mewɔa dɔ o.

Ðe mate ŋu ana baclofen ƒe atikekui bubu siwo woano le aƒeme ko ne vinye ƒe baclofen pɔmpi dze ɖiɖi gɔme alo wòwu enua?¶

Ne dɔnɔa nyɔ bliboe eye wòte ŋu mia nu dedie la, ele be nàna baclofen si woano ƒe agbɔsɔsɔ si woŋlɔ na wo enumake, gake ele be nàyi dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ tẽ kokoko. Baclofen si womi metsoa ʋu kple ahɔhɔ̃ ƒe mɔxenu la nyuie kura o, eye wòɖoa tsi si le aklã me ƒe alafa ɖeka le miligram ɖeka me ne wotsɔe sɔ kple esi wodona ɖe aklã me. Ŋuɖoɖo ɖe baclofen ƒe atikekui siwo woano ɖeɖeko ŋu le aƒeme na ame gbogbo aɖewo siwo ŋu woŋlɔ nu tsoe ku le alɔ̃madɔmadɔ si mexɔa dzo o, 41 C (106 F) dzoxɔxɔ si gbɔ eme, kple ŋutinu geɖe ƒe dɔmawɔmawɔ nyuie ta.

Ne baclofen pɔmpia MELE ɖiɖim o la, ɖe ema ɖo kpe edzi be dɔnɔa mele baclofen ɖeɖeɖa me oa?¶

Ao. Ðeko pɔmpia ƒe kɔmpiuta si le eme la nya ne ŋusẽ le batri la ŋu, ne tsidzraɖoƒea ƒe ɣeyiɣidzidzenu gblɔ be tsi gakpɔtɔ li, kple ne mɔ̃a ƒe ʋuƒoa le tɔtrɔm; sensor aɖeke mele esi le catheter tube si te ŋu trɔna bɔbɔe si yia akɔta la me o. Ne catheter la ʋuʋu, gbã, eɖe kadodo ɖa le pɔmpia ƒe nugbɔ ŋu, alo do le aklã ƒe mɔa me yi megbe ami me la, pɔmpia yia edzi nɔa ɣli dom kpoo esime atike aɖeke meɖoa aklãa gbɔ o.

Nukatae ɖɔktawo naa lorazepam alo diazepam (Valium) si wodona ɖe ʋuka me hena baclofen ɖeɖeɖa esime wonye atike vovovowo?¶

Baclofen wɔa dɔ le GABA-B xɔlawo ŋu, siwo nu va vɔna vevie eye womesea veve o le pɔmpi me dɔdamɔnu si nɔa anyi didi me. Benzodiazepines abe diazepam, lorazepam, kple midazolam ene tsona kabakaba yia titina lãmekawo me ne wodoe ɖe ʋuka me eye wonaa GABA-A xɔlawo wɔa dɔ le aklã ƒe dɔwɔwɔ ƒe ahɔhɔ̃meka kple ahɔhɔ̃ ƒe mɔ mawo ke dzi. Esia nana chloride-channel ƒe brek si xea mɔ na lãmekawo ƒe dɔwɔwɔ gaɖoa lãmekawo me le aɖabaƒoƒo ʋɛ aɖewo ko me, si wɔnɛ be lãmekawo ƒe ʋuʋu sesẽ, alɔ̃madɔmadɔ, kple dzoxɔxɔ si gbɔ eme la nu tsona esime ɖɔktawo le pɔmpia ɖɔm ɖo.

Nukae nye "kotoku me yɔyɔ" le baclofen pɔmpi gbugbɔgade ɖoɖowɔɣi, eye nukawoe nye nuxlɔ̃amedzesiwo?¶

Kotoku me yɔyɔ dzɔna ne aŋe si wotsɔ gbugbɔa nu me la ƒua du alo mete ŋu gena ɖe pɔmpia ƒe titina silicone septum me o, eye wòdoa tsi baclofen si me tsi sɔ gbɔ ɖo mililita geɖe ɖe ami falɛfalɛ si le ƒodo ƒe ŋutigbalẽ te me le vo me tsɔ wu be wòage ɖe titanium-goa me. Nuxlɔ̃amedzesiwo dometɔ aɖewoe nye be woavuvu alo aƒo pɔmpia le mɔ si mebɔ o nu le pɔmpia ƒe teƒe si wogbugbɔ de tsii me, eye le miniti 30 va ɖo gaƒoƒo 4 me la, lãmekawo ƒe lãmekawo ƒe ʋuʋu vevie, alɔ̃dɔdɔ vevie, nuƒoƒo si me mekɔ o, gbɔgbɔ blewu si me goglo o, kple alɔ̃madɔmadɔ kplɔe ɖo. Amesiame si alɔ̃ dɔm le mɔ si mesɔ o nu alo eƒe lãme ʋuʋu le gaƒoƒo ʋɛ aɖewo megbe tso esime wogade pɔmpi me la hiã dɔnɔdzikpɔʋu enumake.

Dzɔtsoƒewo kple dziɖuɖumegãwo ƒe mɔfiame¶

• US Food and Drug Administration (FDA) & Medtronic Neuromodulation: Nyatakakawo ŋɔŋlɔ kple Nuxlɔ̃ame si le aɖaka me na Lioresal Intrathecal / Gablofen (Baclofen Injection) kple SynchroMed II/III Programmable Infusion Systems (Dzesidede kple dzikpɔkpɔ kpata le intrathecal baclofen ɖeɖeɖa kple kotoku me yɔyɔ fũu akpa ŋu).
• Coffey RJ kple ame bubuwo. (Archives of Physical Medicine and Rehabilitation): Baclofen ƒe asiɖeɖe le eŋu kpata: Dɔléle si ate ŋu ade agbe afɔku me ƒe dzesidede kple edzikpɔkpɔ (Pathophysiology of spinal GABA-B receptor downregulation, neuropathic pruritus without rash, rhabdomyolysis, and DIC).
• Saulino M kple ame bubuwo. (Ahɔhɔ̃mekawo ƒe tɔtrɔ: Mɔ̃ɖaŋununya le Ahɔhɔ̃mekawo ƒe Dɔwɔƒe): Nuwɔna Nyuitɔ Kekeakewo Na Intrathecal Baclofen Therapy: Kuxiwo Gbɔkpɔkpɔ Kple ITB Kpatawo Dzikpɔkpɔ (Mɔfiame Siwo Dzi Woda Asi Ðo le Catheter ƒe kpododonu didi, Catheter Access Port aspiration, kple IV benzodiazepine/cyproheptadine xɔname ŋu).
• Dukɔa ƒe Lãmesẽnyawo Gbɔkpɔha (NHS England) & Dukɔa ƒe Lãmesẽnyawo Kple Belélename Ŋuti Nusrɔ̃ƒe (NICE, United Kingdom): Dɔdaƒe ƒe Dɔwɔɖoɖo: Intrathecal Baclofen for Severe Spasticity in Aults and Children.
• Watve S. V. kple exɔlɔ̃wo. (Akɔta): Baclofen ƒe agbɔsɔsɔme si gbɔ eme kple agbɔsɔsɔ si mede edeƒe o dzi kpɔkpɔ: Lumbar Puncture CSF Drainage kple ICU Supportive Care Protocols.

Mɔfiame siwo do ƒome kplii¶

• Serotonin ƒe dɔléle, ahɔhɔ̃mekawo ƒe dɔléle vɔ̃ɖi, kple atikewo ƒe kadodo ɖekae
• Autonomic dysreflexia le aklã ƒe abixɔxɔ me
• Status epilepticus, alɔ̃madɔmadɔ ɣeyiɣi didi, kple xɔnametikewo
• Ayiku ƒe abixɔxɔ sesẽ, rhabdomyolysis, kple aɖuɖɔtoe ƒe agbagbadzedze viviti ƒe vovototodedeameme
• Ame tsitsiwo ƒe CPR kple AED zazã