The effectiveness of epidural blood patch in patients with cerebral palsy treated with intrathecal baclofen implantation

Neurological adverse events associated with baclofen: a pharmacovigilance study based on FDA adverse event reporting system

Background

Baclofen, a centrally acting muscle relaxant, is widely utilized for the management of muscle spasms and alcohol use disorders associated with conditions. However, its neurological safety and tolerability in a large population remain limited. This study aimed to assess the neurological safety and potential risks of baclofen in the real world.

Methods

Data covering the period from the first quarter of 2004 to the third quarter of 2024 were collected from the Food and Drug Administration Adverse Event Reporting System (FAERS). Four disproportionality analysis methods were employed: the Reporting Odds Ratio, the Proportional Reporting Ratio, Bayesian Confidence Propagation Neural Network, and the Multi-item Gamma Poisson Shrinkage (MGPS). These methods were used to detect and evaluate adverse events Adverse drug events associated with baclofen. Additionally, the time to onset analysis was conducted.

Results

A total of 432 neurological-related preferred terms (PTs) were identified. The number of PT that were positive for all four algorithms was 40, and the top 5 PT were Hypotonia, Encephalopathy, Coma, Unresponsive to stimuli, and Cerebrospinal fluid leakage. The top 5 PTs for ROR values are Intracranial hypotension [ROR 66.24 (55.45-79.13)], Cerebrospinal fluid leakage [ROR 51.34 (45.84-57.51)], Autonomic dysreflexia [ROR 47.4 (32.27-69.63)], Basal ganglion degeneration [ROR 33.03 (18.54-58.84)], Sciatic nerve palsy [ROR 21.6 (11.14-41.87)]. The median onset time for baclofen -related ADEs was 27 days. Most cases (n = 241, 55.5%) occurred within the first month of baclofen administration. In an analysis of severe vs. non-severe ADEs, the study found that the incidence of severe cases was higher than that of non-severe cases, with no gender-related differences observed.

Conclusion

This study identified clinically significant PTs using four different algorithms and performed gender subgroup analysis. The TTO analysis indicated that the onset of most ADEs occurred within 27 days. Furthermore, the frequency of severe ADEs was higher than that of non-severe ones. Clinicians should closely monitor for neurological adverse effects caused by baclofen, particularly severe ADEs, and consider individualized dosing strategies. Further research based on real-world data is needed to validate these findings.

Postdural Puncture Headache-Risks and Current Treatment

PURPOSE OF REVIEW

This manuscript aims to review the risks and the current treatments for postdural puncture headache (PDPH).

RECENT FINDINGS

PDPH is a relatively frequent complication after neuraxial blocks. It is typically orthostatic in nature, presenting as a positional and dull aching or throbbing headache, with added dysregulation of auditory and/or visual signals. Certain characteristics, such as female sex and young age, may predispose patients to the development of PDPH, as may factors such as previous PDPH, bearing down during the second stage of labor, and the neuraxial technique itself. Long-term complications including chronic headache for years following dural puncture have brought into question of the historical classification of PDPH as a self-limiting headache. So far, the underlying mechanism governing PDPH remains under investigation, while a wide variety of prophylactic and therapeutic measures have been explored with various degree of success. In case of mild PDPH, conservative management involving bed rest and pharmacological management should be used as first-line treatment. Nerve blocks are highly efficient alternatives for PDPH patients who do not respond well to conservative treatment. In case of moderate-to-severe PDPH, epidural blood patch remains the therapy of choice. An interdisciplinary approach to care for patients with PDPH is recommended to achieve optimal outcomes.

Pediatric Intracranial Hypotension and Post-Dural Puncture Headache

Pediatric intracranial hypotension can occur acutely following iatrogenic dural puncture for diagnostic or therapeutic purposes, or chronically from cerebrospinal fluid leak. The incidence of intracranial hypotension in children is not fully known. However, many steps can be taken to reduce the risk of a child developing a post-dural puncture headache. Other causes of intracranial hypotension, such as spontaneous intracranial hypotension or CSF fistulas, are rare and with little pediatric data to guide evaluation and management. This manuscript reviews the risk factors, diagnostic evaluations, and treatments for post-dural puncture headache, as well as a limited discussion of spontaneous intracranial hypotension as it may pertain to children and adolescents.