Baclofen nervous system

Baclofen is a GABA agonist at GABA B receptors and it has a presynaptic inhibitory function by reducing calcium influx. Its indication is increased extensor tone and clonus. Intrathecal administration may control severe spasticity pain. It is used for the treatment of spastic movement, especially in instances of spinal cord injury, spastic diplegia, multiple sclerosis and amyotrophic lateral sclerosis. Its central nervous system effects include drowsiness, somnolence and seizure activity in epileptic patients. 

Baclofen is structurally related to gamma-aminobutyric acid (GABA), an inhibitory central nervous system transmitter it inhibits reflex activity mainly in the spinal cord. Baclofen reduces spasticity and flexor spasms, but as it has no action on voluntary muscle power, function is commonly not improved. Ambulant patients may need their leg spasticity to provide support and reduction of spasticity may expose the weakness of the limb. It benefits some cases of trigeminal neuralgia. Baclofen is given orally (tVj 3 h). 

Spasticity results from lesions at various sites within the central nervous system and spinal cord. Drugs used include the GABA agonist baclofen, diazepam and tizanidine (an Oj-adrenoceptor agonist). 

Altered consciousness is a major adverse effect of baclofen, because of its GABA-mimetic effects. While this reflects global nervous system depression, other adverse effects, such as seizures and dyskinesias, are probably better explained by selective effects on different brain areas. A case of akinetic mutism associated with baclofen might be an example of this (1). 

The client should be warned not to consume any alcohol while taking baclofen. Baclofen is a central nervous system depressant, as is alcohol. The combination of alcohol and baclofen could intensify the depressant effects. 

Nervous system In a study of the usefulness of intrathecal baclofen in severe spastic hemi-paresis after stroke in eight patients, six had functional deterioration and weakening of the paretic side, with walking disability [44 ]. 

Asymmetric addition of 4-chlorophenylboronic acid (2u) to a,P-unsaturated y-amino ester (26a), followed by deprotection and ester hydrolysis gave optically active 4-amino-3-(4-chlorophenyl)butyric acid (Baclofen) hydrochloride (Scheme 4.10), which plays an important role in various nervous system functions. The best result was observed with a large excess of organoboronic acids (5.0 equiv to 26a) in a 10 1 dioxane-water mixture containing aqueous cesium carbonate [24]. 

Saissy JM, Vitris M, Demaziere J, Seek M, Marcoux L, Gaye M. Flumazenil counteracts intrathecal baclofen-induced central nervous system depression in tetanus. Anesthesiology 1992 76(6) 1051-3. 

Nervous system A randomised, double-blind, crossover study of 12 healthy adults with risperidone demonstrated significant dose-dependent effects on balance control. This effect was observed at low doses with no clinically detectable extrapyramidal symptoms [249 -]. Pisa syndrome is a dystonia affecting cervical and lumbar musculature that has been reported with risperidone, paliperidone and chlorpromazine. A case is presented of a 31-year-old male with MS and FDD who developed Pisa syndrome after chronic risperidone treatment showed improvement with lurasidone, but recurrence with chlorpromazine [250 ]. Another case in a 23-year-old female with history of seizure due to periventricular focal nodular heterotopia occurring 12 months after risperidone treatment she was eventually managed on olanzapine and baclofen PSI ]. A case of persistent Parkinsonism in an 84-year-old male after 5 months of risperidone (2 mg per day) is reported [252 ]. Other dystonic phenomena reported with risperidone include dislocation of the temporomandibular joint [253 ]. 

Stiff person syndrome is a rare disorder of the central nervous system characterised by stiffness and muscle spasms that may be progressive in nature. When oral medication is inadequate to control muscle spasticity, intrathecal baclofen may be used. 

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