Baclofen-induced Encephalopathy in Patients with End-stage Kidney Disease –
A Case Series

Nahla      Kharraz; Hebah      Al Jaghoub; Hamzeh      Alsubbah; Dhanya      Mohan; Fakhriya      Alalawi; Amna      Alhadari

doi:10.2174/03666220909092340

Abstract

Introduction/Background: Baclofen is a centrally acting GABA B receptor agonist, widely used for the treatment of neurological diseases ranging from hiccups to multiple sclerosis. As the drug is renally excreted, intoxication can rapidly develop in those patients with a reduced glomerular filtration rate. A strong index of clinical suspicion is essential to correctly diagnose the condition.

Case Presentation: We report a case series of patients with advanced kidney disease and baclofen-induced encephalopathy that settled with discontinuation of the drug and hemodialysis sessions.

Conclusion: We report this cluster of patients with baclofen toxicity to highlight the common occurrence of neurotoxicity after its use in patients with end-stage renal disease and its resolution after cessation of the drug and hemodialysis sessions.

Keywords: Baclofen, Encephalopathy, Hemodialysis, ESKD, Kidney Disease, Neurotoxicity.

[1]
Dario A, Tomei G. A benefit-risk assessment of baclofen in severe spinal spasticity. Drug Saf  2004; 27(11): 799-818.
 [http://dx.doi.org/10.2165/00002018-200427110-00004] [PMID: 15350152]

[2]
Young RR, Delwaide PJ. Drug therapy: Spasticity (first of two parts). N Engl J Med  1981; 304(1): 28-33.
 [PMID: 6448959]

[3]
Chou CL, Chen CA, Lin SH, Huang HH. Baclofen-induced neurotoxicity in chronic renal failure patients with intractable hiccups. South Med J  2006; 99(11): 1308-9.
 [http://dx.doi.org/10.1097/01.smj.0000247632.84949.27] [PMID: 17195438]

[4]
Khazneh E, Shamlawi A, Jebrin K, Hamdan Z, Sawalmeh O. Single-dose baclofen-induced neurotoxicity in a patient with end stage renal disease: case report. BMC Nephrol  2018; 19(1): 352.
 [http://dx.doi.org/10.1186/s12882-018-1167-z] [PMID: 30537935]

[5]
Radhakrishnan H. Baclofen-induced neurotoxicity in a patient with end-stage renal disease. Saudi J Kidney Dis Transpl  2016; 27(3): 595-7.
 [http://dx.doi.org/10.4103/1319-2442.182437] [PMID: 27215257]

[6]
Beladi Mousavi SS, Mousavi MB, Motemednia F. Baclofen-induced encephalopathy in patient with end stage renal disease: Two case reports. Indian J Nephrol  2012; 22(3): 210-2.
 [http://dx.doi.org/10.4103/0971-4065.98762] [PMID: 23087558]

[7]
Meillier A, Heller C, Patel S. Baclofen-induced encephalopathy in end stage renal disease. Case Rep Med  2015; 2015: 1-3.
 [http://dx.doi.org/10.1155/2015/203936] [PMID: 26294912]

[8]
Kumar A, Khrime D, Bansal N, Agarwal S, Sharma U. Baclofen induced encephalopathy in patients with chronic kidney disease. J Clin Diagn Res  2020; 14(9): R01-02.
 [http://dx.doi.org/10.7860/JCDR/2020/44729.13998]

[9]
Aisen ML, Dietz M, McDowell F, Kutt H. Baclofen toxicity in a patient with subclinical renal insufficiency. Arch Phys Med Rehabil  1994; 75(1): 109-11.
 [http://dx.doi.org/10.1016/0003-9993(94)90347-6] [PMID: 8291951]

[10]
Wu VC, Lin SL, Lin SM, Fang CC. Treatment of baclofen overdose by haemodialysis: A pharmacokinetic study. Nephrol Dial Transplant  2005; 20(2): 441-3.
 [http://dx.doi.org/10.1093/ndt/gfh297] [PMID: 15615812]

[11]
Dias LS, Vivek G, Manthappa M, Acharya RV. Role of hemodialysis in baclofen overdose with normal renal function. Indian J Pharmacol  2011; 43(6): 722-3.
 [PMID: 22144783]

[12]
Ghannoum M, Berling I, Lavergne V, et al. Recommendations from the EXTRIP workgroup on extracorporeal treatment for baclofen poisoning. Kidney Int  2021; 100(4): 720-36.
 [http://dx.doi.org/10.1016/j.kint.2021.07.014] [PMID: 34358487]

[13]
Roberts JK, Westphal S, Sparks MA. Iatrogenic baclofen neurotoxicity in ESRD: Recognition and management. Semin Dial  2015; 28(5): 525-9.
 [http://dx.doi.org/10.1111/sdi.12400] [PMID: 26096760]