Intrathecal baclofen alleviates autonomic dysfunction in severe brain injury

Sympathetic storm phenomena are well known therapeutic problems in patients with severe brain injury. We have treated four patients with intrathecal b aclofen (ITB) who suffered from severe hypertension, tachycardia and other sympathetic storm phenomena after different primary events. In all patients conventional therapy with sedatives and antiadrenergic medication had been taken to the upper limits before initiating ITB. Autonomic dysfunction imm ediately improved in three of four patients. In all patients ITB, via lumba r or ventricular route, proved safe and without complications. The anatomic al and pharmacological basis of the GABA-B agonist action on such sympathet ic storm phenomena are not yet fully understood. However, the positive resu lts observed in three out of four patients are promising and require furthe r investigation. ITB is a new therapeutic approach to control otherwise unr esponsive sympathetic storm phenomena in severe brain injury. (C) 2000 Harc ourt Publishers Ltd.