Baclofen在慢性透析病患引起的神經毒性：一病例報告及文獻回顧

The Neurotoxicity Induced by Baclofen in a Chronic Dialysis Patient: A Case Report and Literature Review

Baclofen是中樞神經傳導物質GABA的促效劑（Agonist），它的臨床治療用途包括脊髓病變引起的僵硬症（Spasticity）、難治性打嗝（Intractable hiccup）、三叉神經痛（Trigeminal neuralgia）、半面痙攣（Hemifacial spasm）、及遲發性不自主運動（Tardive dyskinesia）等。Baclofen經身體代謝後主要由腎臟排除，因此腎臟功能不良患者特別容易因baclofen劑量累積體內所導致風險。已經有一些文獻報告在末期腎臟病患者所見之baclofen相關的腦病變。在此，我們報導一接受血液透析病患，因血尿而服用baclofen並引起腦病變的案例。病患經停止服用baclofen，並接受4小時血液透析後意識改善。2天後病患再接受另一次血液透析，之後病患的意識完全恢復。我們查證文獻報告，共有13例血液透析病患及5例腹膜透析病患，因baclofen造成腦病變被報導。我們分析這些病例發現，血液透析可成功的治療baclofen腦病變，但腹膜透析的療效則尚有爭議。我們建議baclofen不適用於腎衰竭患者，特別是末期腎衰竭患者。盡速執行血液透析則可移除baclofen神經毒性。

Baclofen, a centrally acting GABA agonist, is often prescribed as therapy for spasticity of spinal origin. It has also been used to treat intractable hiccups, trigeminal neuralgia, hemifacial spasm, and tardive dyskinesia in psychiatric patients. Since baclofen is expelled chiefly by the kidneys, patients with weakened renal function are placed at particular risk of toxic build-up. Several observations of baclofen-associated encephalopathy have been reported in patients with end stage renal disease (ESRD). We report here the case of a hemodialysis patient who also developed encephalopathy following baclofen therapy for dysuria and gross hematuria. Baclofen was stopped and hemodialysis for four hours was performed. His conscious level then improved. Another four hours of hemodialysis was performed two days later and the patient’s consciousness recovered completely. According to the previous reports, 18 uremic patients (13 HD and 5 CAPD) have been found to have neurological toxicity induced by baclofen. Successful treatment by HD seems universal, but the effect of CAPD has not been fully made clear. We therefore advise caution against baclofen therapy in renal failure patients, especially in ESRD, although prompt hemodialysis can reverse baclofen neurotoxicity.