Session Information
Date: Monday, September 23, 2019
Session Title: Myoclonus
Session Time: 1:45pm-3:15pm
Location: Les Muses, Level 3
Objective: Clonidine is a centrally acting alpha(2)-agonist antihypertensive drug used for opioid/alcohol withdrawal and for intrathecal administration in the treatment of chronic neuropathic pain. Cases of clonidine withdrawal causing life-threatening hypertensive crisis and stress-induced cardiomyopathy after pump removal or due to pump malfunction are extremely rare.
Background: A 58-year-old woman with chronic neuropathic pain was treated for a 10 year period with intrathecal morphine and clonidine in combination (daily dose of 53,624 mg and 22,343 µg).
Method: At the end of battery life, the patient was scheduled for pump replacement (Medtronic Synchromed 2).
Results: After replacement, the pump was reprogrammed 2 hours after surgery with the same dosis rates and concentrations of medication as before. The patient then complained about back pain, twitching of back muscles and nausea. Piritramid (7,5mg) and Zopiclon (7,5mg) were administrated. Shortly thereafter blood pressure increased to 249/118 mmHg, pulse frequency to 140 bpm, O2 saturation decreased to 74% and temperature rose to 37,7 °C. The patient became obtunded and presented myoclonic movements of the whole body. She was intubated and ventilated and was admitted to the ICU. Serum CK, CK-MB, Troponine-T and Myoglobine were markedly elevated. She was extubated on the following day and had retrograde amnesia for the past few days. The neurological status was normal and the myoclonus had completely subsided. The pump showed no signs of malfunction.
Conclusion: Withdrawal of continuous clonidine and morphine may manifest within a very short period after cessation of drug administration. It may result in the subacute onset of a life-threatening situation characterized by obtundation and generalized myoclonus. Early intervention can reverse this unusual withdrawal syndrome and may lead to rapid recovery.
To cite this abstract in AMA style:
A. Saryyeva, J. Krauss, L. Cassini Ascencao. Acute hypertensive crisis with myoclonic movements induced by withdrawal of intrathecal combined clonidine and morphine administration [abstract]. Mov Disord. 2019; 34 (suppl 2). https://www.mdsabstracts.org/abstract/acute-hypertensive-crisis-with-myoclonic-movements-induced-by-withdrawal-of-intrathecal-combined-clonidine-and-morphine-administration/. Accessed November 24, 2024.« Back to 2019 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/acute-hypertensive-crisis-with-myoclonic-movements-induced-by-withdrawal-of-intrathecal-combined-clonidine-and-morphine-administration/