Haloperidol as an Abortive and Preventative Agent in Status Dystonicus (P2.352)

We present two cases with histories of severe spasms, necessitating intrathecal baclofen pump placement, who both required intubation for status dystonicus. It was not until use of haloperidol as a preventative and abortive agent, that there was significantly decreased spasm frequency and severity in these patients. Cases: Patient 1 is a 40-year-old man with cerebral palsy and spasms controlled with a baclofen pump who was admitted for increasing spasms. Treatment with trihexyphenidyl, increasing amounts of baclofen (oral and intrathecal) and onabotulinumtoxinA injections lessened spasm frequency but did not eliminate them. High doses of diazepam and lorazepam (greater than 70 and 50mg respectively) also failed to control his spasms, so he was intubated and sedated with propofol. After continuing to have spasms on propofol, haloperidol 5mg IV was started for abortive therapy and this proved effective. Haloperidol 5mg PO TID was given standing as prophylaxis and he has done well since. Patient 2 is a 48-year-old man with neurofibromatosis type-1 who presented with increasing full-body spasms despite a functioning baclofen pump. He was uptitrated to a regimen of clonzapeam 1mg BID, dantrolene 25 daily, tizanidine 8mg TID, and lorazepam 10-15 mg IV as needed. These spells proved refractory and when their frequency continued to increase accompanied by brief periods of apnea, he was intubated and sedated with propofol. Haloperidol 5 mg TID was initiated as prophylaxis with better ...
Source: Neurology - Category: Neurology Authors: Tags: Movement Disorders: Therapeutics Source Type: research