Abstract Details

Title Baclofen Toxicity Presenting as Generalized Myoclonus and Choreoathetosis Without Altered Consciousness in the Setting of Acute-on-chronic Kidney Disease

Topic General Neurology

Presentation(s) P11 - Poster Session 11 (11:45 AM-12:45 PM)

Poster/Presentation
Number 7-011

Objective To highlight that baclofen toxicity can present primarily with hyperkinetic movements, without impaired consciousness

Background

Baclofen is renally cleared, and neurotoxicity in chronic kidney disease (CKD) is well described, often presenting with encephalopathy. Involuntary hyperkinetic movements without altered mental status are rarely reported.

Design/Methods A 65-year-old man with CKD (baseline serum creatinine 2.27), ischemic cardiomyopathy, and atrial fibrillation presented with hematemesis and acute kidney injury (serum creatinine 3.7). He had been prescribed baclofen 10 mg three times daily two months earlier for back pain. The patient reported subtle fidgeting movements for ~6 months, but two days prior to admission he developed abrupt, disabling abnormal movements. The clinical examination revealed multifocal asynchronous jerks of the limbs consistent with positive and negative myoclonus. He also had involuntary, non-rhythmic, flowing, and writhing movements of the arms, legs, and the face, consistent with choreoathetosis. Movements were distractible, suppressible, absent during sleep, and interfered with gait and daily function. Mental status was preserved. CT head showed chronic right parietal encephalomalacia without acute changes.

Results Given worsening renal function and ongoing baclofen use, baclofen toxicity was considered likely, despite preserved mentation. The movements improved dramatically within 24 hours of hemodialysis and discontinuation of baclofen, with only mild baseline movements persisting.

Conclusions

Baclofen toxicity can mimic primary movement disorders and can present with acute onset of generalized myoclonus and choreoathetosis even in the absence of encephalopathy. Although baclofen-induced neurotoxicity characteristically presents with altered mental status, clinicians should maintain high suspicion for it in patients with renal injury and other suggestive symptoms. Prompt recognition is critical, as symptoms are rapidly reversible with dialysis.

Authors/Disclosures
Shivaansh Aggarwal, MD PRESENTER	Shivaansh Aggarwal, MD has nothing to disclose.
Soroush Kakawand, MD (University of Oklahoma Health Sciences Center)	Dr. Kakawand has nothing to disclose.
Evan Mooney, MD	Evan Mooney has nothing to disclose.
Sarah R. Durica, MD	An immediate family member of Dr. Durica has received personal compensation in the range of $100,000-$499,999 for serving as a Employee with Federal Aviation Administration.

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