Disclosures: Zakari R. Dymock, MD, MS: No financial relationships or conflicts of interest

Case Diagnosis: Spastic quadriplegic cerebral palsy with underlying dystonia

Case Description: A 27-year-old female with spastic quadriplegic cerebral palsy with underlying dystonia utilizes an intrathecal baclofen (ITB) pump for spasticity management. She had continued persistently uncontrolled dystonia over the course of six months. Multiple dosing increases were made resulting in minimal control of her dystonic component. Upon presentation her dystonia remained uncontrolled despite a simple continuous total daily dose of 1,968.8 mcg/day of intrathecal baclofen at a concentration of 2,000 mcg/dL. Additionally, after her previous increase, she appeared to be suffering from systemic side effects of baclofen including lethargy, decreased appetite and questionable brief episodes of disorientation followed by lethargy. Given the new onset of symptoms plus her continued uncontrolled dystonia, the patient’s intrathecal pump was transitioned to a mixed medication regimen of baclofen (2,000 mcg/dL) plus clonidine (150 mcg/ml) with a 10% reduction in her daily dose of baclofen, now at a simple continuous rate of 1,847.8 mcg/day, with the addition of clonidine at 138.59 mcg/day.

Setting: Outpatient Physiatry ClinicAssessment/

Results: At one month follow-up, the patient reported a significant improvement in her symptoms. She was less lethargic, more active, had an increased appetite and reported no further episodes of disorientation along with controlled dystonia. The patient was seen again at 3 months since the initial transition to a mixed intrathecal pump with continued improvement in symptoms.

Discussion: This case represents a novel, off-label, use of intrathecal clonidine for uncontrolled dystonia. Parenteral use of clonidine for dystonia is well documented in the literature, however, there is limited to no evidence for use of intrathecal clonidine.

Conclusion: Intrathecal clonidine may improve dystonia control when added to intrathecal baclofen, and could be considered as adjunct therapy in the management of dystonia.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/off-label-use-of-intrathecal-clonidine-for-treatment-of-uncontrolled-dystonia-a-case-report/