Failure of Physostigmine in Treatment of Acute Severe Intrathecal Baclofen Intoxication

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Abstract
Intrathecal baclofen, supplied by implanted drugdelivery systems, has now been established as an effective treatment for spinal spasticity1 and is currently being explored for its usefulness in treating supraspinal spasticity.2 Overdosage is an inherent risk of this approach, with respiratory depression being of most concern in patients with this condition, as has been pointed out in letters to the Editor (Nov. 16 issue).3 , 4 Intravenous physostigmine has been proposed as an "antidote,"5 , 6 but our experience casts doubt on its value in cases of severe intrathecal baclofen overdose.