Volume 28, Issue 4 (10-2025)
J Arak Uni Med Sci 2025, 28(4): 0-0 |
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Mobedi M. Oral Baclofen Withdrawal: A Case Report of an Iranian Infant with Gastroesophageal Reflux Disease, Presenting with Seizure. J Arak Uni Med Sci 2025; 28 (4)
URL: http://jams.arakmu.ac.ir/article-1-7838-en.html
URL: http://jams.arakmu.ac.ir/article-1-7838-en.html
Assistant Professor, Department of Pediatric Neurology, Arak University of Medical Sciences, Arak, Iran , dmobedi95@gmail.com
Abstract: (73 Views)
Baclofen is an agonist for gamma-aminobutyric acid receptors on pre- and postsynaptic neurons in the central nervous system and peripheral nervous system. Baclofen withdrawal causes activation of dopamine and noradrenergic receptors, Symptoms usually develop in 1 to 3 days of cessation, including altered mental status, worsening of spasticity, fever, weakness, autonomic instability, seizure, neuroleptic malignant syndrome, neuropsychiatric manifestations and life-threatening state. It can be observed in patients taking oral or intrathecal baclofen following sudden discontinuation or dose reduction. Baclofen is a commonly used medicine in patients with muscle spasticity. It can also relieve gastroesophageal reflux disease (GERD) symptoms. Here, we report a four-month-old Iranian boy with normal neurodevelopment, who was referral to the pediatric emergency department due to extreme irritability, intense crying, poor feeding, insomnia, staring, and a seizure episode. He was admitted to the pediatric intensive care unit, with initial assessment of vital signs, (mild fever, tachycardia, tachypnea), laboratory tests, (anemia), brain CT (Computed tomography) and EEG (electroencephalogram), that was non-diagnostic. Meningitis also was ruled out. He was started on serum and antibiotic therapy and intravenous phenobarbital, but symptoms and signs not completely improved, and patient was irritable and his poor feeding was continued. Further history revealed, gastroesophageal reflux disease in patient, treated with oral baclofen for three months and running out of it 3 days ago. Baclofen was restarted at same dose as before withdrawal with symptomatic improvement. The patient was transferred to the neurology department and then discharged in good general condition with oral baclofen and phenobarbital. Phenobarbital was tapered and discontinued after two weeks, with no recurrence of seizures. After four months of follow-up, the patient was in normal condition. To the knowledge of the author, No cases of seizures after discontinuation of baclofen have been reported in Iranian infants under six months of age with GERD.
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