Sami Ullah, Maha Edrees, Ahmad Mushabbab Alhabtar


Spasticity after spinal cord injury (SCI) is a major problem that can limit the effectiveness of rehabilitation programs. Oral baclofen is more frequently used in treating spasticity than other antispasmodic agents due to its proven overall efficacy. Herein, we are reporting two SCI patients who reported unusual response to baclofen. Case 1 (28-year-old male) his injury was classified as T3 AIS-A. Case 2 (36-year-old male) his injury was classified as T4 AIS-A. Both cases reported worsening of spasms with the initiation of baclofen and the rapid improvement upon discontinuing the medication. The effect was dose-dependent as reported by both of our patients. Our impression is a rebound spasm secondary to baclofen as evident by the severity of spasm and spasticity that were directly proportional to the baclofen dose. Awareness of this reversible side effect is essential for its management. Moreover, it might provide a clue to understanding the mechanism of action of baclofen.

Keywords: Spasticity; Spasms; Baclofen; Spinal Cord Injury; Rehabilitation; Case Series

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Burchiel KJ, Hsu FP. Pain and spasticity after spinal cord injury: mechanisms and treatment. Spine (Phila Pa 1976) 2001;26(24 Suppl):S146–60.

Brainin M, Norrving B, Sunnerhagen KS, Goldstein LB, Cramer SC, Donnan GA, et al. Poststroke chronic disease management: towards improved identification and interventions for poststroke spasticity-related complications. Int J Stroke 2011;6(1):42–6.

Ryu JS, Lee JW, Lee SI, Chun MH. Factors predictive of spasticity and their effects on motor recovery and functional outcomes in stroke patients. Top Stroke Rehabil 2010;17(5):380–8.

Ertzgaard P, Campo C, Calabrese A. Efficacy and safety of oral baclofen in the management of spasticity: A rationale for intrathecal baclofen. J Rehabil Med 2017;49(3):193–203.

Chang E, Ghosh N, Yanni D, Lee S, Alexandru D, Mozaffar T. A review of spasticity treatments: pharmacological and interventional approaches. Crit Rev Phys Rehabil Med 2013;25(1-2):11–22.

Santamato A, Panza F, Ranieri M, Amouruso MT, Amoruso L, Frisardi V, et al. Effect of intrathecal baclofen, botulinum toxin type A and a rehabilitation programme on locomotor function after spinal cord injury: a case report. J Rehabil Med 2010;42(9):891–4.

Rizzo MA, Hadjimichael OC, Preiningerova J, Vollmer TL. Prevalence and treatment of spasticity reported by multiple sclerosis patients. Mult Scler 2004;10(5):589–95.

Meythaler JM, Guin-Renfroe S, Law C, Grabb P, Hadley MN. Continuously infused intrathecal baclofen over 12 months for spastic hypertonia in adolescents’ adults with cerebral palsy. Arch Phys Med Rehabil 2001;82(2):155–61.

Campbell SK, Almeida GL, Penn RD, Corcos DM. The effects of intrathecally administered baclofen on function in patients with spasticity. Phys Ther 1995;75(5):352–62.

Misra A, Ganesh S, Shahiwala A, Shah SP. Drug delivery to the central nervous system: a review. J Pharm Pharm Sci 2003;6(2):252–73.

Jose de A, Luciano P, Vicente V, Juan Marcos AS, Gustavo FC. Role of catheter’s position for final results in intrathecal drug delivery. Analysis based on csf dynamics and specific drugs profiles. Korean J Pain 2013;26(4):336–46.

Ansari S, Akhdar F, Mandoorah M, Moutaery K. Causes and effects of road traffic accidents in Saudi Arabia. Public Health 2000;114(1):37–9.

Alshahri SS, Cripps RA, Lee BB, Al-Jadid MS. Traumatic spinal cord injury in Saudi Arabia: an epidemiological estimate from Riyadh. Spinal Cord 2012;50(12):882–4.

Thilmann A, Fellows SJ, Garms E. The mechanism of spastic muscle hypertonus. Variation in reflex gain over the time course of spasticity. Brain 1991;114(Pt 1A):233–44.

Dressler D, Bhidayasiri R, Bohlega S, Chana P, Chien HF, Chung TM, et al. Defining spasticity: a new approach considering current movement disorders terminology and botulinum toxin therapy. J Neurol 2018;265(4):856–62.

Elbasiouny S, Moroz D, Bakr MM, Mushahwar VK. Management of Spasticity After Spinal Cord Injury: Current Techniques and Future Directions. Neurorehabil Neural Repair 2009;24(1):23–33.

Graham LA. Management of spasticity revisited. Age Ageing 2013;42(4):435–441.

Nair KP, Marsden J. The management of spasticity in adults. BMJ 2014;349:g4737.

Thibaut A, Chatelle C, Ziegler E, Bruno MA, Laureys S, Gosseries O. Spasticity after stroke: Physiology, assessment and treatment. Brain Inj 2013;27(10):1093–105.

Milanov I. Mechanisms of baclofen action on spasticity. Acta Neurol Scand 2009;85(5):305–10.

Watanabe TK. Role of Oral Medications in Spasticity Management. PM R 2009;1(9):839–41.

Pérez-Arredondo A, Cázares-Ramírez E, Carrillo-Mora P, Martínez-Vargas M, Cárdenas-Rodríguez N, Coballase-Urrutia E, et al. Baclofen in the Therapeutic of Sequele of Traumatic Brain Injury: Spasticity. Clin Neuropharmacol 2016;39(6):311–9.

Ryan DM, Blumenthal FS. Baclofen-induced dyskinesia. Arch Phys Med Rehabil 1993;74(7):766–7.

Niehaus MT, Elliott NC, Katz KD. Baclofen Toxicity Causing Acute, Reversible Dyskinesia. J Med Toxicol 2016;12(4):406–7.


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