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Context: Episodic attacks of autonomic dysreflexia AD are regularly experienced by patients with a spinal cord injury SCI on T6 or higher levels. The episodes can result in a pounding headache, flushing, blurred vision, anxiety, a stroke, posturing, hyperthermia, retinal bleeding, seizures, myocardial ischemia, cardiac arrhythmias, and death. The observed associated bradycardia is explained as a baroreceptor reflex response to the high blood pressure. This case highlights the occurrence of intractable AD after removal of the ITB delivery system because of a pump pocket infection. He developed Staphylococcus aureus and Pseudomonas aeruginosa cellulitis at the orifice of his suprapubic catheter, which caused an abscess in the pump pocket. Postoperatively, he experienced severe AD and was treated with, clonidine, and urapidil. The next day, the severely fluctuating blood pressure and pulse rate were no longer controllable with the medication. At L, a temporary external intrathecal catheter for reinitiating ITB was inserted. With this treatment, the AD and the spasticity symptoms could be controlled.

In some countries, like France, Australia, or Germany, baclofen has been used at patient-tailored dose regimens, which can reach mgpd or even more in some patients. Other frequent neuropsychiatric ADRs can occur, i. More rarely, other serious ADRs have been reported, like seizures, manic symptoms, or sleep apnea. However, real-life AUD patients are also exposed to other sedative drugs, like alcohol of course, but also benzodiazepines, other drugs of abuse, or other sedative medications. Consequently, the occurrence of neuropsychiatric safety issues in these patients is essentially the result of a complex multifactorial exposure, in which baclofen causality is rarely obvious by itself.

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Objective : To demonstrate the potential value of ITB Therapy for patients who are experiencing severe spasticity and may be candidates for the therapy. Description : The first module provides an introduction to assessing spasticity.

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