Q: 52 year old male with chronic pain and muscle spasm problem and on baclofen pump brought to ED with delirium and mental status change.


Answer: Baclofen withdrawal syndrome

Abrupt withdrawal of baclofen due to mechanical or other reason may cause serious and even life-threatening symptoms including fluctuation of consciousness, agitation, restlessness, delusions, hallucinations, delirium, tachycardia, autonomic changes, seizures, spasticity and tremors. Severe rebound spasm may cause severe rhabdomyolysis.

Treatment is to resume the drug. If intrathecal route is not available, oral replacement should be started ASAP.