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2.
World Neurosurg ; 139: e652-e657, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32339729

RESUMO

BACKGROUND: Intrathecal baclofen (ITB) is an effective treatment for spasticity, and therapeutic levels may be optimized using surgically implanted pumps. Though these devices are effective, complications can pose significant challenges to patients, decreasing the therapeutic effect and potentially requiring reoperation. As such, it is critical that complications associated with ITB be effectively characterized. METHODS: We queried the Manufacturer and User Facility Device Experience (MAUDE) database for cases reported during the past 3 years documenting adverse events specifically related to ITB pumps. We identified 1935 adverse events that were individually analyzed and categorized by type of complication. RESULTS: Out of the 1935 unique adverse events identified from the MAUDE database, 25.7% were device-related complications (n = 497). Of those, 50.3% were catheter-specific (n = 250), 21.3% (n = 106) were pump-specific, and 28.3% (n = 141) were included, more generally, in catheter or device erosion. CONCLUSIONS: The MAUDE database may be a useful resource for evaluating ITB pump complications across a larger data set. By characterizing the complications and providing values for their total occurrences, patients and physicians may have more realistic expectations for the outcomes and morbidity of this device.


Assuntos
Baclofeno/administração & dosagem , Baclofeno/efeitos adversos , Relaxantes Musculares Centrais/administração & dosagem , Relaxantes Musculares Centrais/efeitos adversos , Baclofeno/uso terapêutico , Infecções Relacionadas a Cateter/epidemiologia , Cateteres/efeitos adversos , Bases de Dados Factuais , Falha de Equipamento , Feminino , Migração de Corpo Estranho , Humanos , Bombas de Infusão Implantáveis , Injeções Espinhais , Masculino , Relaxantes Musculares Centrais/uso terapêutico , Espasticidade Muscular/tratamento farmacológico , Estudos Retrospectivos , Resultado do Tratamento
3.
Drug Alcohol Depend ; 205: 107693, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31751873

RESUMO

BACKGROUND: High-risk combinations of controlled medications, such as those involving opioid analgesics, are under increased scrutiny because of their contribution to the opioid epidemic in the United States. Responsible prescribing guidelines indicate that the triple drug combination--opioids, benzodiazepines and skeletal muscle relaxants, especially carisoprodol--should not be concurrently prescribed. METHODS: This pharmacoepidemiologic study was designed to primarily examine the characteristics of patients receiving this triple combination compared to the group receiving only opioids and benzodiazepines. RESULTS: Results show that, while the number of exposed patients has declined since 2012, approximately 17,000 Floridians were prescribed this combination in 2017 alone. Demographically, recipients of these prescriptions were younger, more likely to be female, and geographically-localized. Furthermore, these patients were more frequently associated with a prescriber in the top 1% of opioid and/or benzodiazepine prescribing, have more multiple provider episodes ("doctor shopping"), and receive higher mean daily opioid dosages. CONCLUSIONS: These findings raise important questions as to how frequently prescribers are checking prescription drug monitoring programs, following US Centers for Disease Control and Prevention opioid prescribing guidelines, and/or handling the clinical challenges associated with pharmaceutical management of patients with complex, painful health conditions.


Assuntos
Analgésicos Opioides/administração & dosagem , Benzodiazepinas/administração & dosagem , Carisoprodol/administração & dosagem , Relaxantes Musculares Centrais/administração & dosagem , Padrões de Prática Médica/tendências , Programas de Monitoramento de Prescrição de Medicamentos/tendências , Adolescente , Adulto , Idoso , Analgésicos Opioides/efeitos adversos , Benzodiazepinas/efeitos adversos , Carisoprodol/efeitos adversos , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Prescrições de Medicamentos/normas , Quimioterapia Combinada , Feminino , Florida/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/efeitos adversos , Dor/tratamento farmacológico , Dor/epidemiologia , Padrões de Prática Médica/normas , Programas de Monitoramento de Prescrição de Medicamentos/normas , Adulto Jovem
4.
Acta Dermatovenerol Croat ; 27(3): 184-187, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542063

RESUMO

Bullous pemphigoid (BP) is an autoimmune disorder which is usually chronic, with blistering that predominantly affects the skin and occasionally the mucosa, and which includes several different types. One of them is a very rare dyshidrosiform type which is localized on the hands and feet with small or large blisters on the palmoplantar surfaces. BP resulting from a drug reaction is a relatively rare occurrence, and so far more than 50 different medications have been identified as triggers. The aim of this article was to present the case of a paraplegic patient who developed this rare dyshidrosiform type of BP while he was being neurologically treated with baclofen. In spite of therapy with systemic and topical corticosteroids and other measures, successful treatment was achieved only after eliminating baclofen from the patient's regimen. His general state of health was seriously endangered due to nasal and skin methicillin-resistant Staphylococcus aureus (MRSA), urinary infection, and oral mycosis (soor), and he was at high risk of sepsis and a fatal outcome. Through our efforts, however, we managed to achieve an excellent outcome. According to our knowledge, this was the first case of baclofen-induced dyshidrosiform BP.


Assuntos
Baclofeno/efeitos adversos , Staphylococcus aureus Resistente à Meticilina , Relaxantes Musculares Centrais/efeitos adversos , Penfigoide Bolhoso/induzido quimicamente , Infecções Estafilocócicas/complicações , Infecções Urinárias/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/complicações , Penfigoide Bolhoso/patologia
5.
J Pediatr Rehabil Med ; 12(3): 313-315, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476182

RESUMO

A 9-year old male patient with a past medical history of congenital cytomegalovirus (CMV) infection and spastic quadriplegic cerebral palsy with an intrathecal baclofen pump was admitted to a tertiary care hospital with respiratory depression and unresponsiveness for approximately two days. He had a recent two-week hospital stay for respiratory failure due to pneumonia. After being prescribed antibiotics and being sent home, he had developed copious diarrhea. On readmission, he was found to be dehydrated and in acute renal failure. A physical exam revealed hypotonia throughout, in a patient who typically had spasticity with contractures. The Pediatric Rehabilitation Medicine service was consulted for possible baclofen toxicity. Some signs and symptoms of baclofen toxicity include respiratory depression, seizures, CNS depression, hypotonia, hypotension, absent deep tendon reflexes, lethargy, ataxia, and cardiac arrhythmias. His intrathecal baclofen (ITB) dose was reduced, and signs/symptoms of ITB overdose began to resolve. As renal function improved, spasticity returned, necessitating increase in ITB dosing toward the premorbid dose.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Baclofeno/administração & dosagem , Baclofeno/efeitos adversos , Relaxantes Musculares Centrais/administração & dosagem , Relaxantes Musculares Centrais/efeitos adversos , Criança , Humanos , Injeções Espinhais , Masculino
7.
J Sex Med ; 16(10): 1518-1528, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31501059

RESUMO

INTRODUCTION: Although fibromyalgia symptoms negatively affect patients' sexual life, sexual desire in women diagnosed with fibromyalgia has been understudied. AIM: To describe and compare sexual desire in women diagnosed with fibromyalgia and healthy control women, and to investigate the influence of fibromyalgia and its pharmacologic treatment on sexual desire among women diagnosed with fibromyalgia. METHODS: 164 women diagnosed with fibromyalgia participated in the study. Participants' sexual desire, fibromyalgia symptoms, symptom interference in daily life activities, and perceived quality of life were measured. Further sociodemographic and health-related data were also recorded. 87 healthy women were selected as a control group, and their sexual desire was compared with those of women diagnosed with fibromyalgia. MAIN OUTCOME MEASURES: Main outcome measures included the Sexual Desire Inventory and the Fibromyalgia Impact Questionnaire. RESULTS: When compared with healthy control subjects, women diagnosed with fibromyalgia exhibited a significantly lower mean score on total desire (47.92 ± 17.48 vs 26.33 ± 21.95; P < .001), solitary desire (10.52 ± 5.96 vs 5.74 ± 7.01; P < .001), and dyadic desire (37.40 ± 13.98 vs 20.59 ± 16.94; P < .001). Women diagnosed with fibromyalgia who were taking antidepressants scored significantly lower on dyadic desire (P < .001), solitary desire (P < .001), and total desire (P < .001) than those who were not. Furthermore, a negative correlation between desire (dyadic and solitary) and Revised Fibromyalgia Impact Questionnaire (total and all subscales) was found. Linear regression showed that taking antidepressants, age, and the total Fibromyalgia Impact Questionnaire score explained 16% of the variance of total desire. CLINICAL IMPLICATIONS: Knowing how fibromyalgia symptoms and their pharmacologic treatment affect women's sexual desire may have implications for designing care strategies according to individual needs. STRENGTHS & LIMITATIONS: To the best of our knowledge, this is the first study that focuses on studying the impact of fibromyalgia on dyadic and solitary sexual desire. Limitations are related to having used an online questionnaire for data collection, having recruited the participants through a convenience sampling technique and not being able to isolate whether certain results are related to fibromyalgia symptoms or are side effects of the pharmacologic treatment used for symptom control. CONCLUSION: Fibromyalgia impact seems to negatively influence dyadic and solitary sexual desire in women. In addition, other factors such as age or taking antidepressant drugs may result in lower sexual desire in these patients. López-Rodríguez MM, Pérez Fernández A, Hernández-Padilla JM, et al. Dyadic and Solitary Sexual Desire in Patients With Fibromyalgia: A Controlled Study. J Sex Med 2019;16:1518-1528.


Assuntos
Fibromialgia/psicologia , Libido/fisiologia , Comportamento Sexual/psicologia , Adulto , Distribuição por Idade , Idoso , Analgésicos/efeitos adversos , Antidepressivos/efeitos adversos , Estudos de Casos e Controles , Feminino , Fibromialgia/tratamento farmacológico , Hormônios/efeitos adversos , Humanos , Libido/efeitos dos fármacos , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/efeitos adversos , Qualidade de Vida , Disfunções Sexuais Psicogênicas/induzido quimicamente , Disfunções Sexuais Psicogênicas/etiologia , Inquéritos e Questionários , Saúde da Mulher , Adulto Jovem
8.
J Clin Neurosci ; 68: 33-38, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31400999

RESUMO

Intrathecal baclofen infusion trial is a sophisticated tool for selecting patients for permanent intra thecal baclofen infusion therapy We report our clinical experience of fifteen patients with refractory spasticity who underwent a continuous ITB trial using a temporary intraspinal indwelling catheter prior to permanent pump implantation. Patients underwent placement of a temporary intrathecal catheter that was connected to an external pump. Multisource feedback was obtained from the various healthcare professionals involved (Staff Nurse, Specialist nurse, physiotherapist, Doctor, family members, patient) regarding progress of test over 48-72 h. Average Modified Ashworth score after the trial was less than 2. Some degree of dose related minor adverse events (AEs) occurred in 8 patients, with the most common being nausea, constipation, urinary retention and hypotension. 10 patients received pump implant. 5 patients did not receive a pump because of AEs or because the goals were not met. 1 patient had pump removed after 4 years because of infection.


Assuntos
Baclofeno/administração & dosagem , Relaxantes Musculares Centrais/administração & dosagem , Espasticidade Muscular/tratamento farmacológico , Seleção de Pacientes , Idoso , Baclofeno/efeitos adversos , Cateteres de Demora , Feminino , Humanos , Bombas de Infusão Implantáveis , Injeções Espinhais , Masculino , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/efeitos adversos , Estudos Retrospectivos
9.
Arch Phys Med Rehabil ; 100(5): 837-843, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31030729

RESUMO

OBJECTIVE: To report our experience using continuous intrathecal baclofen (ITB) administration prior to a possible ITB device implantation. DESIGN: Retrospective open label study. Mean duration of follow-up 64 months. SETTING: Primary-care and referral center, ambulatory and hospitalized care. PARTICIPANTS: Patients (N=116) undergoing continuous ITB trials between 2006 and 2017. INTERVENTIONS: Continuous application of baclofen via a temporary intrathecal catheter connected to an external pump. MAIN OUTCOME MEASURES: Assessment of the modified Ashworth Scale and range of movement prior versus end of ITB trial. According to the Barthel Index, definition of high-level patients (60-100 scoring points) and low-level patients (0-55 scoring points). Calculation of the Rivermead Mobility Index in high-level patients prior versus end of ITB trial. Evaluation of occurring adverse events. RESULTS: A total of 119 ITB trials were performed in 116 patients (78 men, mean age 41±16), 113 patients completed the trials (31 of 113 high level, 82 of 113 low level). The median modified Ashworth scale improved from 4 (interquartile range [IQR] 3-4) to 2 (IQR 1-2; P≤.001), the range of movement from 2 (IQR 1-3) to 3 (IQR 3-3; P≤.001). The Rivermead Mobility Index increased from 9 (IQR 6-12) to 10 (IQR 7-12.5; P=.004) in high-level patients. Eighty-eight out of 113 patients (78%) were appropriate candidates for ITB device surgery, 75 of 88 (85%) proceeded to an implantation. A total of 69 adverse events occurred in 57 of 119 trials (48%), 37 of 69 (54%) were drug related, 32 of 69 (46%) were procedure related, and 42 of 69 (61%) were minor. The ITB device was implanted in 69 of 75 patients (92%) at last follow-up. CONCLUSIONS: Continuous administration of ITB is an effective and useful alternative to ITB bolus application during ITB screening period. Half of the patients experienced adverse events; the majority were minor events.


Assuntos
Baclofeno/administração & dosagem , Bombas de Infusão Implantáveis , Relaxantes Musculares Centrais/administração & dosagem , Espasticidade Muscular/tratamento farmacológico , Adulto , Músculos do Dorso , Baclofeno/efeitos adversos , Feminino , Marcha , Humanos , Infusão Espinal , Masculino , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/efeitos adversos , Seleção de Pacientes , Equilíbrio Postural , Estudos Retrospectivos
10.
Saudi J Kidney Dis Transpl ; 30(2): 513-516, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31031388

RESUMO

Thiocolchicoside (TCC) is a widely used centrally acting muscle relaxant. Epileptic seizures from the use of TCC are rarely reported. A 67-year-old male patient with endstage renal disease that was caused by hypertension was on maintenance hemodialysis (HD) for 22 months. He had taken TCC 8 mg capsules twice daily for four days due to painful myofascial spasm in neck and face muscles. At the end of the HD session, he had generalized tonic-clonic seizures. Epileptic seizures were brought under control with sodium valproate, and no recurrence of epileptic seizures was observed.


Assuntos
Colchicina/análogos & derivados , Falência Renal Crônica/terapia , Relaxantes Musculares Centrais/efeitos adversos , Convulsões/induzido quimicamente , Idoso , Colchicina/efeitos adversos , Humanos , Masculino , Diálise Renal
11.
J Hum Lact ; 35(3): 559-562, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31017819

RESUMO

INTRODUCTION: Cyclobenzaprine is a skeletal muscle relaxant primarily used in the treatment of pain. Its use during lactation is a matter of concern as its level of exposure to infants through human milk is still unknown. MAIN ISSUE: The aim of this study was to determine cyclobenzaprine concentrations in the milk samples collected from two lactating mothers. MANAGEMENT: The present study describes the analysis of cyclobenzaprine in human milk using liquid chromatography mass spectrometry, which determined the drug concentration-time profiles in human milk. CONCLUSION: This study shows low levels of concentrations of cyclobenzaprine in human milk with calculated relative infant dose of 0.5%. However, due to the sedative properties of cyclobenzaprine, regular clinical assessment of the infant is recommended to evaluate for long-term effects.


Assuntos
Amitriptilina/análogos & derivados , Aleitamento Materno , Leite Humano/química , Relaxantes Musculares Centrais/efeitos adversos , Dor/tratamento farmacológico , Cuidado Pré-Natal , Adulto , Amitriptilina/efeitos adversos , Amitriptilina/farmacocinética , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Espectrometria de Massas , Leite Humano/metabolismo , Relaxantes Musculares Centrais/farmacocinética , Gravidez
12.
Clin Obstet Gynecol ; 62(1): 37-47, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30614847

RESUMO

In this article, we describe a variety of medications that physicians managing outpatient chronic pain should familiarize themselves with to better aid their approach to multimodal pain therapy. Physicians should always consider the use of an adjuvant or coanalgesic drug as first-line treatments. Although many of these medications are not primarily analgesics, in clinical practice they have independent analgesic effects or synergistic analgesic properties when used with opioids. The use of adjunct analgesics reduces opioid-related adverse effects and optimizes pain management. Although there may be some medication overlap with this section and the ERAS section, the purpose of this article is to understand prolonged use in the outpatient setting to reduce opioid use or limit opioid dose with adjuvant therapy.


Assuntos
Analgésicos Opioides/efeitos adversos , Dor Crônica/tratamento farmacológico , Manejo da Dor/métodos , Acetaminofen/uso terapêutico , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/efeitos adversos , Antidepressivos Tricíclicos/administração & dosagem , Antidepressivos Tricíclicos/efeitos adversos , Benzodiazepinas/administração & dosagem , Benzodiazepinas/efeitos adversos , Capsaicina/administração & dosagem , Capsaicina/efeitos adversos , Quimioterapia Adjuvante , Feminino , Humanos , Relaxantes Musculares Centrais/administração & dosagem , Relaxantes Musculares Centrais/efeitos adversos , Receptores de N-Metil-D-Aspartato/antagonistas & inibidores , Inibidores da Recaptação de Serotonina e Norepinefrina/administração & dosagem , Inibidores da Recaptação de Serotonina e Norepinefrina/efeitos adversos
13.
Clin Pharmacol Ther ; 105(3): 703-709, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30223305

RESUMO

Tizanidine, a widely used muscle relaxant that can lower blood pressure, is metabolized by the cytochrome P450 1A2 (CYP1A2). We studied 1,626 patients prescribed tizanidine and 5,012 prescribed cyclobenzaprine concurrently with a strong CYP1A2 inhibitor. The primary outcome was severe hypotension, defined as systolic blood pressure (SBP) ≤ 70 mmHg during periods of drug co-exposure. Severe hypotension occurred more often in the tizanidine group (2.03%; n = 33) than the cyclobenzaprine group (1.28%; n = 64); odds ratio (OR) = 1.60; P = 0.029. This difference remained statistically significant after adjustment for a log-transformed propensity score that included age, sex, race, Charlson's comorbidity index, and concurrent use of antihypertensive medications (OR = 1.57; P = 0.049). A sensitivity analysis that defined hypotension as SBP < 90 mmHg also yielded higher rates of hypotension among patients prescribed tizanidine. In conclusion, CYP1A2 inhibition increases the risk of hypotensive episodes associated with the use of tizanidine in routine clinical practice.


Assuntos
Clonidina/análogos & derivados , Inibidores do Citocromo P-450 CYP1A2/efeitos adversos , Citocromo P-450 CYP1A2/metabolismo , Hipotensão/induzido quimicamente , Hipotensão/metabolismo , Relaxantes Musculares Centrais/efeitos adversos , Adulto , Clonidina/administração & dosagem , Clonidina/efeitos adversos , Estudos de Coortes , Inibidores do Citocromo P-450 CYP1A2/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Hipotensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/administração & dosagem , Polimedicação , Estudos Retrospectivos , Fatores de Risco
14.
Neuromodulation ; 22(7): 834-838, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30325089

RESUMO

BACKGROUND: Intrathecal (IT) Baclofen is beneficial for spasticity, but if pumps become infected necessitating removal, baclofen withdrawal is difficult to manage and life-threatening. Furthermore there is no consistency between dosing and severity of withdrawal. Case reports detail full baclofen withdrawal at dosages of 260 µg/day. OBJECTIVE: To demonstrate that in patients on stable IT baclofen for prolonged periods, externalizing a patient's original IT pump is a safe, effective way to wean IT doses. METHODS: Here, we describe a technique of continuing IT baclofen when urgent pump removal is needed. Specifically, we remove the infected pump. Then using a new or existing lumbar drain based on extent of infection, we reconnect the pump after cleaning with betadine and administer therapy externally during IT weaning. RESULTS: Hundred forty seven baclofen pumps were implanted or replaced within four years. Infections occurred in seven patients. We utilized this technique in five of seven patients. Mean IT dose at time of explant was 400.5 ± 285.3 µg/day. We titrated the dose by 20-50% per day based on clinical response over a mean of 6.2 ± 1.3 days. The catheter was removed at bedside once weaning was complete. No patients had any signs of withdrawal, excluding minimal spasticity increases while optimizing oral treatment. CONCLUSION: Here, we show preliminary evidence that an externalized IT pump is an effective means of weaning IT baclofen when infection of the pump occurs. This treatment strategy warrants further investigation, but appears to be a safe and effective. CONFLICT OF INTEREST: Dr. Pilitsis is a consultant for Medtronic, Boston Scientific, Nevro, Jazz Pharmaceuticals, Neurobridge Therapeutics, and Abbott and receives grant support from Medtronic, Boston Scientific, Abbott, Nevro, Jazz Pharmaceuticals, GE Global Research and NIH 1R01CA166379. She is medical advisor for Centauri and Karuna and has stock equity. Dr. Sukul receives consultant fees from Medtronic. Julia Prusik receives grant support from Jazz Pharmaceuticals.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Baclofeno/administração & dosagem , Contaminação de Equipamentos , Bombas de Infusão Implantáveis , Relaxantes Musculares Centrais/administração & dosagem , Síndrome de Abstinência a Substâncias/prevenção & controle , Adulto , Idoso , Baclofeno/efeitos adversos , Feminino , Seguimentos , Humanos , Bombas de Infusão Implantáveis/normas , Masculino , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/efeitos adversos , Povidona-Iodo/administração & dosagem
15.
Eur J Gastroenterol Hepatol ; 31(4): 499-502, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30444744

RESUMO

BACKGROUND: Muscle cramps occur in 29-88% of patients with liver cirrhosis. They adversely affect quality of life. This study aimed to evaluate the efficacy and safety of methocarbamol as a novel therapy in controlling muscle cramps in cirrhotic patients. PATIENTS AND METHODS: This study was carried on 100 patients with liver cirrhosis in addition to chronic hepatitis C who presented with frequent muscle cramps (≥three cramps per week). Half of these patients received methocarbamol and the other half received placebo. This was done through equal randomization. Questionnaires on muscle cramp were answered. Patients were evaluated before, after 1 month of treatment, and 2 weeks after washout of treatment in terms of severity, duration, and frequency of cramps. Liver, renal functions, and electrolytes were analyzed. Also, any side effect was detected. RESULTS: Patients who were treated with methocarbamol showed a significant decrease in the frequency and duration of cramps. Also, the pain score improved significantly. However, no significant changes were observed in the placebo group. Few side effects of methocarbamol were recorded, including dry mouth and drowsiness. CONCLUSION: Methocarbamol seems to be a promising safe and well-tolerated medication, and plays a role in the treatment of muscle cramps in patients with liver cirrhosis.


Assuntos
Cirrose Hepática/complicações , Metocarbamol/uso terapêutico , Cãibra Muscular/tratamento farmacológico , Relaxantes Musculares Centrais/uso terapêutico , Adulto , Idoso , Método Duplo-Cego , Feminino , Hepatite C Crônica/complicações , Humanos , Cirrose Hepática/virologia , Masculino , Metocarbamol/efeitos adversos , Pessoa de Meia-Idade , Cãibra Muscular/etiologia , Relaxantes Musculares Centrais/efeitos adversos , Dor/prevenção & controle , Resultado do Tratamento
17.
Childs Nerv Syst ; 35(1): 15-18, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30417210

RESUMO

INTRODUCTION: Intrathecal baclofen (ITB) is an effective treatment for managing primary and secondary dystonia. Intraventricular baclofen (IVB) was first developed to allow treating patients in which the use of ITB was difficult due to anatomic anomalies. After that, several studies indicate that intraventricular administration of baclofen, is more effective than ITB in refractory dystonia. CLINICAL MATERIAL: We report three cases of children with acute dystonic and dysautonomic storm, treated with IVB. The clinical outcome was satisfactory. The response to the treatment continued after the pump disconnection, suggesting that in this kind of cerebral dysregulations, short-term IVB is an effective treatment. CONCLUSION: Early treatment with IVB may be an effective option in patients with post-anoxic dysautonomic and dystonic storm.


Assuntos
Doenças do Sistema Nervoso Autônomo/tratamento farmacológico , Baclofeno/administração & dosagem , Baclofeno/uso terapêutico , Distonia/tratamento farmacológico , Relaxantes Musculares Centrais/administração & dosagem , Relaxantes Musculares Centrais/uso terapêutico , Adolescente , Doenças do Sistema Nervoso Autônomo/complicações , Baclofeno/efeitos adversos , Criança , Distonia/complicações , Feminino , Humanos , Hipóxia Encefálica/complicações , Bombas de Infusão Implantáveis , Injeções Intraventriculares , Masculino , Relaxantes Musculares Centrais/efeitos adversos , Prevenção Secundária , Resultado do Tratamento
20.
Pediatrics ; 142(2)2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29976571

RESUMO

Intrathecal baclofen pumps are commonly used in pediatric patients with spastic cerebral palsy. Baclofen binds to γ-aminobutyric acid receptors to inhibit both monosynaptic and polysynaptic reflexes at the spinal cord level. The blockade stops the release of excitatory transmitters and thereby decreases muscle contraction. It is commonly used for lower limb spasticity and has been shown to improve postural ability and functional status. The US Food and Drug Administration has approved baclofen for the treatment of spasticity of cerebral or spinal origin in adult and pediatric patients 4 years or older. Various complications of baclofen pumps are described in the literature. Immediately after surgery, problems from infection can arise and range from superficial skin infections to meningitis and bacteremia. Another early complication includes cerebrospinal fluid leak that can be observed by notable swelling beneath the lumbar incision. Additional problems that arise later are usually from the mechanics of the pump and catheter. Pump-related complications include failure, migration, and flipping. Catheter-related complications include disconnection, occlusion, fracture, or kink. Most of these complications typically lead to baclofen withdrawal, although there are a few case reports of overdose due to mechanical causes. Here we describe 2 cases of individuals experiencing complications of excessive baclofen exposure after significant changes in the atmospheric pressure due to travel involving ambient altitude change. These cases reflect the need to discuss this potential complication with families and patients with baclofen pumps before travel to high elevations.


Assuntos
Altitude , Pressão Atmosférica , Baclofeno/efeitos adversos , Relaxantes Musculares Centrais/administração & dosagem , Sonolência , Pensamento/efeitos dos fármacos , Adolescente , Baclofeno/administração & dosagem , Feminino , Humanos , Injeções Espinhais , Masculino , Relaxantes Musculares Centrais/efeitos adversos , Pensamento/fisiologia
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