Maryam Mobedi ,
Volume 28, Issue 4 (10-2025)
Abstract
Introduction: Baclofen, a GABA-B receptor agonist, acts on presynaptic and postsynaptic neurons in the central and peripheral nervous systems. Baclofen withdrawal causes activation of dopamine and noradrenergic receptors. Symptoms usually develop in 1 to 3 days of cessation, including altered mental status, worsening of spasticity, fever, weakness, autonomic instability, seizures, neuroleptic malignant syndrome, neuropsychiatric manifestations, and a life-threatening state. It can be observed in patients taking oral or intrathecal baclofen following sudden discontinuation or dose reduction. Baclofen is a commonly used medicine in patients with muscle spasticity. It can also relieve gastroesophageal reflux disease (GERD) symptoms.
Case Report: Here, we report a four-month-old Iranian boy with normal neurodevelopment who was referred to the pediatric emergency department due to extreme irritability, intense crying, poor feeding, insomnia, staring, and a seizure episode. He was admitted to the pediatric intensive care unit, with initial assessment of vital signs (mild fever, tachycardia, tachypnea), laboratory tests (anemia), brain CT (computed tomography), and EEG (electroencephalogram), which were non-diagnostic. Meningitis also was ruled out. He was started on serum and antibiotic therapy and intravenous phenobarbital, but symptoms and signs did not completely improve, and the patient was irritable and his poor feeding was continued. Further history revealed GERD treated with oral baclofen for three months, which had been discontinued three days prior to admission. Baclofen was restarted at the previous dosage, resulting in rapid symptomatic improvement. The patient was transferred to the neurology department and then discharged in good general condition with oral baclofen and phenobarbital. Phenobarbital was tapered and discontinued after two weeks without seizure recurrence.
Conclusions: After four months of follow-up, the patient was in normal condition. To the author's knowledge, no cases of seizures after discontinuation of baclofen have been reported in Iranian infants under six months of age with GERD.
