혈액투석 환자에서 Baclofen 뇌증 1예 = A Case of Baclofen-Associated Encephalopathy in a Maintenance Hemodialysis Patient

다국어 초록 (Multilingual Abstract)

Baclofen, a derivative of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), is used for the treatment of muscle spasm, intractable hiccups and multiple sclerosis. It is mostly excreted by glomerular filtration with a clearance that is proportional to creatinine clearance. Early hemodialysis is a treatment of the choice for baclofen-induced neurologic complication in renal failure patients. We experienced a 57-year-old hemodialysis patient with right arm muscle spasm who developed baclofen-associated encephalopathy by a single dose of oral baclofen (10 mg). He admitted to the hospital with the symptom of stuporous mental status with no specific focal neurologic signs. Brain CT imaging and blood biochemistry showed no specific abnormality. EEG revealed the typical metabolic encephalopathy findings, such as triphasic wave and frontal lobe syndrome with delta wave. After daily hemodialysis for 3 days, there was a complete recovery of an altered mentality. After one month later, the follow-up EEG showed normal finding with the resolution of abnormal waves. We report this case with a review of relevant literature. Baclofen should be used carefully, and rather recommended not to be administered in patients with renal failure.

국문 초록 (Abstract)

Baclofen (β-4-(chlorophenyl)-γ-aminobutyric acid)은 중추 신경계 전달 물질인 gamma-aminobutyric acid (GABA)에 작용하여 근육 경직과 딸꾹질을 비롯한 다양한 신경학적 질환에서 자주 사용하는 약물이다1,2). Baclofen의 주요 부작용은 기면, 입 마름, 변비, 어지러움, 의식 저하가 대표적이며, 말기 신부전 환자에서 baclofen의 사용에 의한 신경학적 부작용도 보고된 바 있다2-5).
국내에서는 재활의학과에서 치료 용량의 baclofen을 근경직 치료를 위해 투여한 후에 요로 감염과 동반된 급성 신부전 환자에서 수면장애, 기면, 환각, 환청, 기억상실, 지남력 장애 등의 증상을 나타낸 환자 2예가 있고6), 뇌졸증이 합병된 복막투석 환자에서 baclofen의 반복 투여로 의식과 호흡 저하가 동반되어 baclofen 뇌증이 의심되었으나 특별한 치료없이 경과 관찰하여 호전되었던 증례가 보고된 바 있다7).
본 저자 등은 10년간 혈액투석 치료를 받아오던 환자에서 오른쪽 상완 근육통으로 baclofen 10 mg을 복용한 후 급격한 의식 저하를 보여 투석 용량을 증가시킨 반복적인 혈액투석 후에 신경학적 증세가 호전된 예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

참고문헌 (Reference)

• 1 "Treatment of Intractable hiccup in haemodialysis patients with baclofen" 21 : 427-427, 2001
• 2 "Toxic effects of baclofen in a patient with chronic renal insufficiency" 58 : 364-366, 2001
• 3 "Severe respiratory depression by low-dose baclofen in the treatment of chronic hiccups in a patient undergoing CAPD" 86 : 546-547, 2000
• 4 "Plasma and urinary excretion kinetics of oral baclofen in healthy subjects" 37 : 181-184, 1989
• 5 "Periodic sharp waves in Baclofen induced encephalopathy" 45 : 814-815, 1988
• 6 "Encephalopathy associated with baclofen" 17 : 617-618, 1985
• 7 "Baclofen 사용에 의한 부작용 - 증례보고" 21 : 229-233, 1997
• 8 "Baclofen toxicity in patients with severely impaired renal function" 31 : 1315-1320, 1997
• 9 "Baclofen toxicity in a patient with subclinical renal insufficiency" 75 : 109-110, 1994
• 10 "Baclofen neurotoxicity in uremic patients : is continuous ambulatory peritoneal dialysis less effective than intermittent hemodialysis?" 25 : 279-305, 2003
• 11 "Baclofen neurotoxicity in chronic haemodialysis patients with hiccups" 13 : 1896-1897, 1998
• 12 "Baclofen neurotoxicity in a chronic haemodialysis patient" 15 : 715-716, 2000
• 13 "Baclofen intoxication in chronic hemodialysis and kidney transplantation" 117 : 733-737, 1992
• 14 "Baclofen induced frontal lobe syndrom:case report" 29 : 554-556, 1991
• 15 "Baclofen in the long-term management of spasticity" 1 : 654-657, 1976
• 16 "Baclofen for intractable hiccups" 319 : 1354-, 1988
• 17 "Baclofen for intractable hiccups" 2 : 562-563, 1989
• 18 "Anti-spasticity drugs:mechanism of action" 17 : 107-116, 1985
• 19 "Akinetic mutism after Baclofen" 115 : 499-500, 1991
• 20 "Aggravated CNS depression with urinary retention secondary to baclofen administration" 145 : 1717-1718, 1985
• 21 "A possible baclofen-induced neurotoxicity in a CAPD patient who recovered with long-duration hemodialysis" 22 : 279-280, 2002