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Baclofen Withdrawal

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181. Dystonias (Treatment)

often requires combinations of several medications, with choices generally guided by empirical trials and adverse effect profiles. Doses should be slowly increased over the course of weeks or months until the therapeutic benefit is optimized or until adverse effects occur. In most patients, discontinuation of the drugs requires tapering to prevent withdrawal symptoms. Baclofen, given intrathecally by an implanted pump, can be very effective in certain types of dystonia, especially if spasticity (...) . Previous Next: Pharmacologic Therapy Medications can be somewhat effective in controlling dystonic movements, but the lack of knowledge about the exact pathophysiology of dystonia has made the development of specific pharmacologic therapies difficult. Systemic medications benefit about one third of patients and consist of a wide variety of options, including the following [ ] : Cholinergics Benzodiazepams Antiparkinsonism drugs Anticonvulsants Baclofen Carbamazepine Lithium Successful drug therapy

2014 eMedicine.com

183. Cocaine (Treatment)

improve cocaine abstinence and was synergistic to pharmacotherapy when used along with standard cognitive behavioral therapy and other psychotherapies. [ ] No pharmacotherapies have been approved for cocaine addiction; but some drugs have been tested with promising results. Disulfiram, amantadine, tiagabine, topiramate, and baclofen are some drugs that have been reported to be of possible benefit in cocaine addiction. Disulfiram has been noted to have a paradoxical effect at lower doses, and, hence (...) dependence showed that modafinil improved clinical outcomes when combined with psychosocial treatment for cocaine dependence. The psychotropic analgesic nitrous oxide has been reported in one blinded trial to be effective for the treatment of acute cocaine withdrawal. In one trial, both quetiapine and risperidone reduced drug cravings from cocaine. [ ] Clonidine may also help lower stress induced by cocaine craving and subsequent relapse. [ ] A recent randomized, double-blind, placebo controlled trial

2014 eMedicine.com

184. Multiple Sclerosis (Treatment)

multifocal leukocephalopathy (PML), an opportunistic infection of the brain that can lead to death or severe disability. The risk of PML seems to increase with a history of previous immunosuppression, duration of exposure to natalizumab beyond 2 years, and JC virus antibody positivity. Three cases of PML associated with natalizumab use prompted its temporary withdrawal from the market in 2005; however, it was reapproved in 2006 by the FDA for commercialization under a special restricted distribution (...) Treat spasticity when it interferes with function, mobility, positioning, hygiene, or activities of daily living. Reducing spasticity can give the patient more freedom of movement with less energy expenditure, as well as avoiding complications such as pain, contractures, and decubitus. Spasticity can be managed through nonpharmacologic means. Pharmacologic treatment of spasticity includes baclofen (Gablofen, Lioresal), which is particularly useful for the relief of flexor spasms and concomitant pain

2014 eMedicine.com

185. Multiple Sclerosis (Treatment)

multifocal leukocephalopathy (PML), an opportunistic infection of the brain that can lead to death or severe disability. The risk of PML seems to increase with a history of previous immunosuppression, duration of exposure to natalizumab beyond 2 years, and JC virus antibody positivity. Three cases of PML associated with natalizumab use prompted its temporary withdrawal from the market in 2005; however, it was reapproved in 2006 by the FDA for commercialization under a special restricted distribution (...) Treat spasticity when it interferes with function, mobility, positioning, hygiene, or activities of daily living. Reducing spasticity can give the patient more freedom of movement with less energy expenditure, as well as avoiding complications such as pain, contractures, and decubitus. Spasticity can be managed through nonpharmacologic means. Pharmacologic treatment of spasticity includes baclofen (Gablofen, Lioresal), which is particularly useful for the relief of flexor spasms and concomitant pain

2014 eMedicine.com

186. Middle Cerebral Artery Stroke (Treatment)

. Table 2. Antispasmodics Mechanisms of Action, Significant Adverse Effects, and Considerations. Drug Mechanism of Action Significant Adverse Effect Consideration Baclofen Inhibits spinal reflexes [ ] Withdrawal syndrome may include hallucinations and seizures [ ] Dose reduction may be needed with renal impairment [ ] Dantrolene Interferes with the release of calcium from the sarcoplasmic reticulum [ ] Both diarrhea and hepatotoxicity are dose dependent and may limit use [ ] Baseline and periodic (...) spasticity. Bracing, especially at night, allows continuous passive range to tight, spastic muscle. This includes serial casting, which allows gradual increase in range over weeks. [ ] Oral medications also are often used for spasticity management, including tizanidine, baclofen, dantrolene, and benzodiazepines. . The functional benefit of these drugs is not well demonstrated despite their common use. These medications often have at least some sedating effect on patients, which should be weighed

2014 eMedicine.com

187. Transient Global Amnesia (Treatment)

characterizes the ischemic lesion in transient global amnesia. Neurology . 1998 Sep. 51(3):901-3. . Chung CP, Hsu HY, Chao AC, et al. Detection of intracranial venous reflux in patients of transient global amnesia. Neurology . 2006 Jun 27. 66(12):1873-7. . Grande LA, Loeser JD, Samii A. Recurrent transient global amnesia with intrathecal baclofen. Anesth Analg . 2008 Apr. 106(4):1284-7, table of contents. . Hinge HH, Jensen TS, Kjaer M, et al. The prognosis of transient global amnesia. Results (...) recurrent familiar transient global amnesia after betablocker treatment withdrawal: case report. Neuro Endocrinol Lett . 2008 Feb. 29(1):44-6. . Zweifler RM. Management of acute stroke. South Med J . 2003 Apr. 96(4):380-5. . Media Gallery of 0 Tables Contributor Information and Disclosures Author Roy Sucholeiki, MD Director, Comprehensive Seizure and Epilepsy Program, The Neurosciences Institute at Central DuPage Hospital Roy Sucholeiki, MD is a member of the following medical societies: , , Disclosure

2014 eMedicine.com

188. Spasticity (Treatment)

. The Croonian lecture 1978. J R Coll Physicians Lond . 1980 Apr. 14(2):72-7, 80. . Coffey RJ, Edgar TS, Francisco GE, Graziani V, Meythaler JM, Ridgely PM, et al. Abrupt withdrawal from intrathecal baclofen: recognition and management of a potentially life-threatening syndrome. Arch Phys Med Rehabil . 2002 Jun. 83 (6):735-41. . Alden TD, Lytle RA, Park TS, Noetzel MJ, Ojemann JG. Intrathecal baclofen withdrawal: a case report and review of the literature. Childs Nerv Syst . 2002 Oct. 18 (9-10):522-5 (...) , wheelchairs, and standers) Oral medications (such as baclofen and dantrolene) [ ] Injectable neurolytic medications (botulinum toxins and phenol) Intrathecal baclofen Surgical intervention (including selective dorsal rhizotomy and orthopedic procedures) See and for more detail. Next: Background Spasticity is increased, involuntary, velocity-dependent muscle tone that causes resistance to movement. The condition may occur secondary to a disorder or trauma, such as a tumor, a stroke, (MS

2014 eMedicine.com

189. Spasticity (Treatment)

. The Croonian lecture 1978. J R Coll Physicians Lond . 1980 Apr. 14(2):72-7, 80. . Coffey RJ, Edgar TS, Francisco GE, Graziani V, Meythaler JM, Ridgely PM, et al. Abrupt withdrawal from intrathecal baclofen: recognition and management of a potentially life-threatening syndrome. Arch Phys Med Rehabil . 2002 Jun. 83 (6):735-41. . Alden TD, Lytle RA, Park TS, Noetzel MJ, Ojemann JG. Intrathecal baclofen withdrawal: a case report and review of the literature. Childs Nerv Syst . 2002 Oct. 18 (9-10):522-5 (...) , wheelchairs, and standers) Oral medications (such as baclofen and dantrolene) [ ] Injectable neurolytic medications (botulinum toxins and phenol) Intrathecal baclofen Surgical intervention (including selective dorsal rhizotomy and orthopedic procedures) See and for more detail. Next: Background Spasticity is increased, involuntary, velocity-dependent muscle tone that causes resistance to movement. The condition may occur secondary to a disorder or trauma, such as a tumor, a stroke, (MS

2014 eMedicine.com

190. Dystonias (Overview)

often requires combinations of several medications, with choices generally guided by empirical trials and adverse effect profiles. Doses should be slowly increased over the course of weeks or months until the therapeutic benefit is optimized or until adverse effects occur. In most patients, discontinuation of the drugs requires tapering to prevent withdrawal symptoms. Baclofen, given intrathecally by an implanted pump, can be very effective in certain types of dystonia, especially if spasticity (...) . Previous Next: Pharmacologic Therapy Medications can be somewhat effective in controlling dystonic movements, but the lack of knowledge about the exact pathophysiology of dystonia has made the development of specific pharmacologic therapies difficult. Systemic medications benefit about one third of patients and consist of a wide variety of options, including the following [ ] : Cholinergics Benzodiazepams Antiparkinsonism drugs Anticonvulsants Baclofen Carbamazepine Lithium Successful drug therapy

2014 eMedicine.com

191. Transient Global Amnesia (Overview)

with intrathecal baclofen. Anesth Analg . 2008 Apr. 106(4):1284-7, table of contents. . Hinge HH, Jensen TS, Kjaer M, et al. The prognosis of transient global amnesia. Results of a multicenter study. Arch Neurol . 1986 Jul. 43(7):673-6. . Lauria G, Gentile M, Fassetta G, et al. Transient global amnesia and transient ischemic attack: a community- based case-control study. Acta Neurol Scand . 1998 Jun. 97(6):381-5. . Otrock ZK, Beydoun A, Barada WM, Masroujeh R, Hourani R, Bazarbachi A. Transient global amnesia (...) after breathing hyperoxic mixtures in otherwise regular dives. Clin Neurol Neurosurg . 2008 Mar. 110(3):259-61. . Vyhnálek M, Bojar M, Jerabek J, Hort J. Long lasting recurrent familiar transient global amnesia after betablocker treatment withdrawal: case report. Neuro Endocrinol Lett . 2008 Feb. 29(1):44-6. . Zweifler RM. Management of acute stroke. South Med J . 2003 Apr. 96(4):380-5. . Media Gallery of 0 Tables Contributor Information and Disclosures Author Roy Sucholeiki, MD Director

2014 eMedicine.com

192. Tourette Syndrome and Other Tic Disorders (Overview)

-depleting agents also improve tics, and in some patients, tics may be worsened by neuroleptic withdrawal or, possibly, stimulant use. However, other data do not support a simple hypothesis that dopamine function is hyperactive in individuals with TS. Tics are not abated with the subsequent development of Parkinson disease. [ ] However, in Parkinson disease, dopamine loss is most evident in posterior putamen, [ ] whereas caudate and ventral striatum are more implicated in TS. Furthermore, dopamine (...) or they withdraw from many activities. Prejudice in work and school settings is common. Tics also interrupt the individual's behavior and thought. Most patients find that they sometimes lose track of a conversation or that they are slow to complete a task because of incessant interruptions by their tics. Self-injurious behavior is not uncommon. Occasionally, self-injury is intentional and due to a comorbid problem (eg, suicide during an episode of major depression). At times self-injury is pseudointentional

2014 eMedicine.com

193. Multiple Sclerosis (Follow-up)

multifocal leukocephalopathy (PML), an opportunistic infection of the brain that can lead to death or severe disability. The risk of PML seems to increase with a history of previous immunosuppression, duration of exposure to natalizumab beyond 2 years, and JC virus antibody positivity. Three cases of PML associated with natalizumab use prompted its temporary withdrawal from the market in 2005; however, it was reapproved in 2006 by the FDA for commercialization under a special restricted distribution (...) Treat spasticity when it interferes with function, mobility, positioning, hygiene, or activities of daily living. Reducing spasticity can give the patient more freedom of movement with less energy expenditure, as well as avoiding complications such as pain, contractures, and decubitus. Spasticity can be managed through nonpharmacologic means. Pharmacologic treatment of spasticity includes baclofen (Gablofen, Lioresal), which is particularly useful for the relief of flexor spasms and concomitant pain

2014 eMedicine.com

194. Multiple Sclerosis (Follow-up)

multifocal leukocephalopathy (PML), an opportunistic infection of the brain that can lead to death or severe disability. The risk of PML seems to increase with a history of previous immunosuppression, duration of exposure to natalizumab beyond 2 years, and JC virus antibody positivity. Three cases of PML associated with natalizumab use prompted its temporary withdrawal from the market in 2005; however, it was reapproved in 2006 by the FDA for commercialization under a special restricted distribution (...) Treat spasticity when it interferes with function, mobility, positioning, hygiene, or activities of daily living. Reducing spasticity can give the patient more freedom of movement with less energy expenditure, as well as avoiding complications such as pain, contractures, and decubitus. Spasticity can be managed through nonpharmacologic means. Pharmacologic treatment of spasticity includes baclofen (Gablofen, Lioresal), which is particularly useful for the relief of flexor spasms and concomitant pain

2014 eMedicine.com

195. Middle Cerebral Artery Stroke (Follow-up)

. Table 2. Antispasmodics Mechanisms of Action, Significant Adverse Effects, and Considerations. Drug Mechanism of Action Significant Adverse Effect Consideration Baclofen Inhibits spinal reflexes [ ] Withdrawal syndrome may include hallucinations and seizures [ ] Dose reduction may be needed with renal impairment [ ] Dantrolene Interferes with the release of calcium from the sarcoplasmic reticulum [ ] Both diarrhea and hepatotoxicity are dose dependent and may limit use [ ] Baseline and periodic (...) spasticity. Bracing, especially at night, allows continuous passive range to tight, spastic muscle. This includes serial casting, which allows gradual increase in range over weeks. [ ] Oral medications also are often used for spasticity management, including tizanidine, baclofen, dantrolene, and benzodiazepines. . The functional benefit of these drugs is not well demonstrated despite their common use. These medications often have at least some sedating effect on patients, which should be weighed

2014 eMedicine.com

196. Rehabilitation of Persons With Spinal Cord Injuries (Diagnosis)

medications are available, which, if necessary, can be used in concert with the interventions listed above. Table 1 provides information regarding pharmacologic agents for the treatment of spasticity. Table 1. Oral Pharmacologic Agents for Treatment of Spasticity Drug Daily Dose Range Common Adverse Effects Baclofen 5-200 mg (in divided doses) Hypotonia Sedation/confusion Withdrawal syndrome Tizanidine 2-36 mg (in divided doses) Fatigue Dry mouth Sedation Elevated LFTs* Clonidine † 0.2-0.6 mg (in divided (...) : Prevention and treatment of noxious stimuli (eg, pressure injury, UTI, urinary tract stone, ingrown toenail) Regular muscle stretching and joint ROM Oral medication (see below) Botulinum toxin injection (useful for treatment of problems caused by specific muscle groups) Intrathecal baclofen delivered by an implanted pump (an involved, but effective, nondestructive treatment) Peripheral procedures (eg, neurolysis and contracture release) Central ablative procedures (eg, rhizotomy and myelotomy) Several

2014 eMedicine Surgery

197. Delirium Tremens (Follow-up)

> Delirium Tremens (DTs) Treatment & Management Updated: Apr 27, 2018 Author: Michael James Burns, MD, FACEP, FACP, FIDSA; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, MCCM Share Email Print Feedback Close Sections Sections Delirium Tremens (DTs) Treatment Approach Considerations Special concerns in the treatment of alcohol withdrawal include the following: Failure to consider the diagnosis of alcohol withdrawal syndrome in patients with altered mental status, abnormal vital signs, or single (...) simple seizure Failure to treat patients with severe alcohol withdrawal syndrome with adequate doses of benzodiazepines, because these patients may require extremely large doses of parenteral benzodiazepines Making the assumption that all seizures in people with alcoholism are due to alcohol withdrawal without considering other causes of seizures, such as infection, hemorrhage, or trauma Failure to exclude other etiologies of altered mental status in patients with suspected alcohol withdrawal Failure

2014 eMedicine.com

198. Dystonias (Follow-up)

often requires combinations of several medications, with choices generally guided by empirical trials and adverse effect profiles. Doses should be slowly increased over the course of weeks or months until the therapeutic benefit is optimized or until adverse effects occur. In most patients, discontinuation of the drugs requires tapering to prevent withdrawal symptoms. Baclofen, given intrathecally by an implanted pump, can be very effective in certain types of dystonia, especially if spasticity (...) . Previous Next: Pharmacologic Therapy Medications can be somewhat effective in controlling dystonic movements, but the lack of knowledge about the exact pathophysiology of dystonia has made the development of specific pharmacologic therapies difficult. Systemic medications benefit about one third of patients and consist of a wide variety of options, including the following [ ] : Cholinergics Benzodiazepams Antiparkinsonism drugs Anticonvulsants Baclofen Carbamazepine Lithium Successful drug therapy

2014 eMedicine.com

199. Transient Global Amnesia (Follow-up)

characterizes the ischemic lesion in transient global amnesia. Neurology . 1998 Sep. 51(3):901-3. . Chung CP, Hsu HY, Chao AC, et al. Detection of intracranial venous reflux in patients of transient global amnesia. Neurology . 2006 Jun 27. 66(12):1873-7. . Grande LA, Loeser JD, Samii A. Recurrent transient global amnesia with intrathecal baclofen. Anesth Analg . 2008 Apr. 106(4):1284-7, table of contents. . Hinge HH, Jensen TS, Kjaer M, et al. The prognosis of transient global amnesia. Results (...) recurrent familiar transient global amnesia after betablocker treatment withdrawal: case report. Neuro Endocrinol Lett . 2008 Feb. 29(1):44-6. . Zweifler RM. Management of acute stroke. South Med J . 2003 Apr. 96(4):380-5. . Media Gallery of 0 Tables Contributor Information and Disclosures Author Roy Sucholeiki, MD Director, Comprehensive Seizure and Epilepsy Program, The Neurosciences Institute at Central DuPage Hospital Roy Sucholeiki, MD is a member of the following medical societies: , , Disclosure

2014 eMedicine.com

200. Spasticity (Follow-up)

. The Croonian lecture 1978. J R Coll Physicians Lond . 1980 Apr. 14(2):72-7, 80. . Coffey RJ, Edgar TS, Francisco GE, Graziani V, Meythaler JM, Ridgely PM, et al. Abrupt withdrawal from intrathecal baclofen: recognition and management of a potentially life-threatening syndrome. Arch Phys Med Rehabil . 2002 Jun. 83 (6):735-41. . Alden TD, Lytle RA, Park TS, Noetzel MJ, Ojemann JG. Intrathecal baclofen withdrawal: a case report and review of the literature. Childs Nerv Syst . 2002 Oct. 18 (9-10):522-5 (...) , wheelchairs, and standers) Oral medications (such as baclofen and dantrolene) [ ] Injectable neurolytic medications (botulinum toxins and phenol) Intrathecal baclofen Surgical intervention (including selective dorsal rhizotomy and orthopedic procedures) See and for more detail. Next: Background Spasticity is increased, involuntary, velocity-dependent muscle tone that causes resistance to movement. The condition may occur secondary to a disorder or trauma, such as a tumor, a stroke, (MS

2014 eMedicine.com

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