From the Guidelines
Seizures occur in approximately 30-40% of adults younger than 30 who experience baclofen overdose. The frequency of seizures in this population is a significant concern, as it can lead to increased morbidity, mortality, and decreased quality of life. According to the most recent evidence, the management of seizures, including those caused by baclofen overdose, involves first-line treatment with benzodiazepines and second-line treatment with agents such as phenytoin, levetiracetam, and valproic acid 1.
Key Considerations
- The risk of seizures increases with higher doses of baclofen, typically when ingestion exceeds 200 mg, which is significantly higher than the normal therapeutic doses of 5-25 mg three to four times daily.
- Seizures from baclofen overdose often present within 6 hours of ingestion and may be accompanied by other symptoms like respiratory depression, coma, hypotonia, and cardiovascular effects.
- The mechanism of baclofen as a GABA-B receptor agonist can cause paradoxical excitation when taken in excessive amounts, leading to disruptions in the brain's normal electrical activity.
Treatment and Management
- Treatment involves supportive care, airway management, and sometimes benzodiazepines for seizure control.
- Anyone suspected of baclofen overdose should receive immediate medical attention, as prompt intervention significantly improves outcomes and reduces the risk of complications from seizure activity.
- It is essential to note that noncompliance with antiseizure drug therapy and the use of prescribed or illicit substances can lower the seizure threshold, making it more challenging to manage seizures in the emergency department 1.
Clinical Implications
- The clinical policy for managing adult patients presenting to the emergency department with seizures emphasizes the importance of prompt and appropriate treatment to prevent complications and improve outcomes 1.
- The policy also highlights the need for careful consideration of the patient's medication history, substance use, and other factors that may influence seizure risk and management.
From the FDA Drug Label
In patients with epilepsy, the clinical state and electroencephalogram should be monitored at regular intervals, since deterioration in seizure control and EEG have been reported occasionally in patients taking baclofen. ...and, rarely, epileptic seizure
The frequency of seizures in adults under 30 with baclofen overdose is not explicitly stated in the drug label. However, it is mentioned that deterioration in seizure control has been reported occasionally in patients taking baclofen, and epileptic seizure is listed as a rare adverse reaction 2 2.
- Seizure frequency is not quantified in the label.
- Age-specific data for adults under 30 is not provided.
- Overdose-specific data is not available.
From the Research
Frequency of Seizures in Adults under 30 with Baclofen Overdose
- The frequency of seizures in adults under 30 with baclofen overdose can be observed in several case studies 3, 4, 5.
- In a study of adolescents who overdosed on baclofen, 2 out of 8 patients experienced tonic-clonic seizures 3.
- A case study of a 23-year-old woman who overdosed on baclofen reported that she manifested seizures as one of the symptoms 4.
- Another case study of a 15-year-old girl who overdosed on baclofen reported that she experienced seizures, along with severe respiratory depression, autonomic disturbances, and coma 5.
- However, it is essential to note that the studies do not provide a comprehensive overview of the frequency of seizures in adults under 30 with baclofen overdose, as the samples are limited and the studies focus on specific cases rather than providing a broad statistical analysis 3, 4, 5.
- Additionally, other studies have reported seizures as a symptom of baclofen overdose, but these studies may not be directly relevant to adults under 30 6, 7.