Buscar en
Neurología (English Edition)
Toda la web
Inicio Neurología (English Edition) Intrathecal baclofen for dystonia treatment during pregnancy: A case report
Journal Information
Vol. 31. Issue 2.
Pages 131-132 (March 2016)
Vol. 31. Issue 2.
Pages 131-132 (March 2016)
Letter to the Editor
DOI: 10.1016/j.nrleng.2014.04.011
Full text access
Intrathecal baclofen for dystonia treatment during pregnancy: A case report
Baclofeno intratecal para el tratamiento de la distonía durante el embarazo: un caso clínico
Visits
...
C. Méndez-Lucenaa,
Corresponding author
dra.mendezlucena@gmail.com

Corresponding author.
, J. Chacón Peñab, J.M. García-Morenoa
a Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain
b Unidad de Neurología, Hospital Infanta Luisa, Sevilla, Spain
Article information
Full Text
Bibliography
Download PDF
Statistics
Full Text
Dear Editor:

Baclofen is an anti-spasmodic drug and muscle relaxant indicated for treating spasticity.1,2 The exact mechanism of action is unclear, although it is believed to be a GABA agonist; it decreases the amount of free aspartate and glutamate, thereby reducing the excitability of alpha motor neurons.3 Typically, baclofen is administered orally to treat spasticity produced by certain conditions. For cases which do not respond adequately to oral administration, or which come with intolerable side effects, there are continuous infusion pumps that administer baclofen intrathecally.4 Baclofen has also been used to treat some cases of dystonia, whether focal or generalised, in patients who do not respond to conventional oral treatments or botulinum toxin injection.5,6 To date, the effects of baclofen use during pregnancy have yet to be fully examined. The FDA has identified baclofen as a category C risk for pregnant women: ‘Animal studies have revealed adverse fetal effects but no controlled studies in women have been done, or no studies in women or animals are available.’ In animal studies completed thus far, baclofen was administered orally and at high doses. No prospective controlled studies evaluating the safety of intrathecal delivery of this drug during pregnancy have been carried out. Furthermore, this medication is prescribed only infrequently in clinical practice.7 The purpose of our letter is to provide additional information about baclofen use during pregnancy by presenting a clinical case.

The case is that of a 30-year-old woman with autosomal dominant DYT1-positive generalised dystonia, with symptoms beginning when she was 11. After various oral medications and an injection of botulinum toxin type A elicited no response, doctors opted to implant an intrathecal baclofen pump at the lumbar level (SynchroMed® II 40ml, as she had responded to a test dose of 100μg). After implantation, the patient remained essentially asymptomatic for 3 years, at which point she became pregnant. She was informed of the possible risks and disadvantages, and decided with her doctors not to have the pump removed, given the good response up to that point. She therefore received a continuous infusion of baclofen dosed at 200μg/day (8.3μg/h) during her entire pregnancy. The patient's pregnancy progressed uneventfully and she gave birth at week 39 to a healthy 3080g baby girl through vacuum-assisted vaginal delivery, without an epidural or any other complications. The patient reported no increases in dystonia symptoms either during or after her pregnancy. The patient breastfed for the first month after which she stopped for personal reasons. Four years later, the patient had an ectopic pregnancy which required surgery and the removal of a fallopian tube. Later, her dystonia symptoms worsened, and her medication was increased to control them (current dose, 600μg/d). The patient remains essentially asymptomatic and is planning another pregnancy. Her daughter is now a healthy 7-year-old with psychomotor development within normal limits.

Articles addressing the effect of baclofen during pregnancy are scarce. Our literature search revealed only 10 reported cases, and there were no prospective controlled studies.7–14 In all of them, the treatment was indicated for a diagnosis of spasticity secondary to a variety of illnesses, such as cerebral palsy (5 cases),7,9,13,14 spinal cord injury (3 cases),7,8,11 tetanus (1 case),10 and multiple sclerosis (1 case).12 Nearly all the patients had their pumps implanted between 15 months and 6.5 years before pregnancy, although in 2 cases the pumps were implanted during the third trimester (week 28-30) due to an increase in spasticity. Most of them underwent planned early caesarian sections, except for 3 patients who gave birth spontaneously and vaginally at term. In our case, as in all the reviewed literature, the newborn did not display any type of illness, anomaly, or disorder, whether neurological, psychomotor, or respiratory. The baclofen dose used in the reported cases ranged between 140 and 1400μg/day (our patient received 200μg). None of the newborns, including our case, showed any teratogenic effects due to baclofen. Although there are no conclusive controlled studies, the information gathered to date appears to show that the use of intrathecal baclofen during pregnancy is completely safe for both mother and baby.

References
[1]
L.A. Graham.
Management of spasticity revisited.
Age Ageing, 42 (2013), pp. 435-441
[2]
Baclofen injection. Drug insert.
Norvartis Pharma AG Basle, Switzerland for Medtronic, Inc., (2002),
[3]
W. Froestl.
Chemistry and pharmacology of GABAb receptor ligands. GABA Receptor Pharmacology: a tribute to Norman Bowery.
Adv Pharmacol, 58 (2010), pp. 19-62
[4]
R.J. Coffey, T.S. Edgar, G.E. Francisco, V. Graziani, J.M. Meythaler, P.M. Ridgely, et al.
Abrupt withdrawal from intrathecal baclofen: recognition and management of a potentially life-threatening syndrome.
Arch Phys Med Rehabil, 83 (2002), pp. 735-741
[5]
D.D. Dykstra, A. Méndez, D. Chappuis, T. Baxter, L. DesLauriers, M. Stuckey.
Treatment of cervical dystonia and focal hand dystonia by high cervical continuously infused intrathecal baclofen: a report of 2 cases.
Arch Phys Med Rehabil, 86 (2005), pp. 830-833
[6]
A.L. Albright, M.J. Barry, D.H. Shafton, S.S. Ferson, A.L. Albright, M.J. Barry, et al.
Intrathecal baclofen for generalized dystonia.
Dev Med Child Neurol, 43 (2001), pp. 652-657
[7]
C.M. Morton, J. Rosenow, C. Wong, K.L. Kirschner.
Intrathecal baclofen administration during pregnancy: a case series and focused clinical review.
[8]
E.M. Delhaas, J. Verhagen.
Pregnancy in a quadraplegic patient treated with continuous intrathecal baclofen infusion to manage her severe spasticity.
Paraplegia, 30 (1992), pp. 527-528
[9]
F.C. Muñoz, D.G. Marco, A.V. Pérez, M.M. Camacho.
Pregnancy outcome in a woman exposed to continuous intrathecal baclofen infusion.
Ann Pharmacother, 34 (2000), pp. 956
[10]
N. Engrand, P. van de Perre, G. Vilain, D. Benhamou.
Intrathecal baclofen for severe tetanus in a pregnant woman.
Eur J Anaesthesiol, 18 (2001), pp. 261-263
[11]
A.G. Roberts, C.R. Graves, P.E. Konrad, T.E. Groomes, A.A. Pfister, M.M. Damian, et al.
Intrathecal baclofen pump implantation during pregnancy.
Neurology, 61 (2003), pp. 1156-1157
[12]
C.M. Dalton, E. Keenan, L. Jarrett, L. Buckley, V.L. Stevenson.
The safety of baclofen in pregnancy: intrathecal therapy in multiple sclerosis.
Mult Scler, 14 (2008), pp. 571-572
[13]
W. Ali Sakr Esa, I. Toma, J.E. Tetzlaff, S. Barsoum.
Epidural analgesia in labor for a woman with an intrathecal baclofen pump.
Int J Obstet Anesth, 18 (2009), pp. 64-66
[14]
M. DeVries-Rizzo, D. Warren, G. Delaney, S. Levin, C. Campbell, S. deRibaupierre.
Intrathecal baclofen and pregnancy: implications for clinical care.
Can J Neurosci Nurs, 31 (2009), pp. 21-24

Please cite this article as: Méndez-Lucena C, Chacón Peña J, García-Moreno JM. Baclofeno intratecal para el tratamiento de la distonía durante el embarazo: un caso clínico. Neurología. 2016;31:131–132.

Copyright © 2014. Sociedad Española de Neurología
Article options
Tools
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos