(Kiosk 3) Intermittent Intrathecal Baclofen Pump Overdose Due to Catheter Microleaks

Case Diagnosis: Patient with spastic quadriparesis presenting with intermittent baclofen overdose secondary to microleak of intrathecal baclofen catheter.

Case Description or Program Description: A female with spastic quadriparesis and seizures following traumatic brain injury had an intrathecal baclofen (ITB) pump placed to manage severe spasticity. Two years later, she presented to the emergency department for unresponsiveness and hypotonia. Medical workup and ITB pump troubleshooting did not identify etiology of symptoms. The patient spontaneously returned to baseline and was discharged home. After this initial presentation, the patient had multiple similar episodes over the following year. These episodes were characteristic of baclofen overdose and further troubleshooting revealed ITB catheter microleaks.

Setting: Academic medical center

Assessment/Results: The patient continued having intermittent unresponsive and hypotonic episodes prompting additional investigation. Repeat infectious work up identified a urinary tract infection which was treated but episodes continued. To rule out, a 72-hour ambulatory EEG was performed in conjunction with baclofen bolus; however, no seizure activity was captured. During an unresponsive episode, 25 ml of clear fluid was aspirated from the ITB catheter access port with immediate resolution of symptoms. A catheter dye study was remarkable for dye extravasation coming from multiple areas of the catheter indicating microleaks throughout the catheter. After ITB pump and catheter replacement, patient has not had any episodes of ITB overdose.

Discussion (relevance): ITB pumps have many advantages in the treatment of severe spasticity; however, pump malfunction can lead to baclofen withdrawal or overdose which can be life threatening. Complications with ITB pumps have been documented; however, catheter microleaks are rarely reported and challenging to discover. We are not aware of reports of episodic ITB overdose due to catheter microleak; thus making this report novel.

Conclusions: Our patient suffered intermittent baclofen overdose due to catheter microleaks, which was successfully treated with ITB pump and catheter replacement. Our patient suffered intermittent baclofen overdose due to catheter microleaks, which was successfully treated with ITB pump and catheter replacement.