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, operating room to fill sterile intrathecal pumps prior to implantation in patients not recommended, unless external surface of prefilled syringe is treated to ensure sterility potentially life-threatening cns depression, cardiovascular collapse, and or respiratory failure resuscitative equipment and trained staff must be available during screening, dose titration, and refills overdose may cause drowsiness, lightheadedness, dizziness, somnolence, respiratory depression, seizures, rostral progression of hypotonia and loss of consciousness progressing to coma possible exacerbation of psychotic disorders, schizophrenia or confusional states may occur intrathecal mass cases of intrathecal mass at the tip of the implanted catheter have been reported, most of them involving pharmacy-compounded analgesic admixtures; the most frequent symptoms associated with intrathecal mass include decreased therapeutic response worsening spasticity, return of spasticity when previously well controlled, withdrawal symptoms, poor response to escalating doses, or frequent or large dosage increases , pain, and neurologic deficit dysfunction inadvertent injection into the sc tissue can occur if the intrathecal reservoir refill septum is not properly accessed; sc injection may result in symptoms of a systemic overdose or early depletion of the reservoir all patients receiving intrathecal baclofen therapy are potentially at risk for withdrawal; early symptoms of baclofen withdrawal may include return of baseline spasticity, pruritus, hypotension, and paresthesias; priapism may develop or recur if treatment with intrathecal baclofen is interrupted.
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patient selection is important when initiating baclofen therapy; it is likely to be of most benefit in patients whose spasticity constitutes a handicap to activities and or physiotherapy.
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