Transcript Jamais Vu Episodes in Relationship to Baclofen Treatment: A Case

Jamais Vu Episodes in Relationship
to Baclofen Treatment:
A Case Report
Terry H. Struck, MD
報告：心理系102鄭幼毅
Outline
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Introduction
Case Description
Discussion
Conclusion
Introduction
Jamais Vu
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Jamais vu is a mental state in which a person
has a sense of unfamiliarity in a familiar
situation.
Jamais vu occurs more frequently in
epileptic patients, during states of fatigue or
intoxication.
Baclofen
Baclofen
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Deterioration in seizure control and EEG
have been reported occasionally in patients
taking baclofen.
Baclofen, 4-amino-3 (p-chlorophenyl) butyric
acid, is structurally similar to GABA.
baclofen may depress neuronal activity in
the central nervous system (CNS) and lower
the seizure threshhold.
Baclofen’s Medical uses
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treatment of spastic movement disorders
especially in instances of spinal cord injury
cerebral palsy
and multiple sclerosis
Its use in people with stroke or Parkinson
disease is not recommended.
treatment of alcohol withdrawal syndrome
Baclofen’s Side effect
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drowsiness
confusion
sedation
memory and attention problems
depression
euphoria
hallucinations of auditory, olfactory, and
visual types
Case Description
Patient
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37-year-old slightly obese man who was
involved in a motor vehicle crash (MVC)
Smoke, Alcoholic drink.
診斷(1)
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An MRI scan of the cervical spine noted mild
C3 through C7 bulging disks but no other
abnormalities.
An EEG of the left upper extremity and
cervical paraspinal region noted mild left
carpal tunnel syndrome and mild left cubital
tunnel syndrome but no other abnormalities.
posttraumatic stress disorder (PTSD)
診斷(2)
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concussion syndrome
benign positional vertigo
left neck and shoulder girdle myofascial pain
syndrome
mild left CTS
mild left cubital tunnel syndrome
PTSD.
Medications
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(1)nonsteroidal anti-inflammatory drugs
(NSAIDs), ibuprofen,Lodine (etodolac) and
then Celebrex (celecoxib)
(2) muscle relaxants, Norflex (orphenadrine),
Flexeril (cyclobenzaprine), Valium
(diazepam), and then Lioresal (baclofen);
(3) pain medications, Darvocet
(propoxyphene and acetaminophen),
Vicodin (hydrocodone), and then Ultram
(tramadol);
Medications
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(4) sleeping medications, Ambien (zolpidem)
and then Sonata (zaleplon)
(5) gastroesophageal reflux disease
medications because of side effects from
NSAID usage, Zantac (ranitidine); Axid
(nizatidine), and then Prilosec (omeprazole);
(6) antidepressant medications, Serzone
(nefazodone);
(7) vertigo medication, Antivert (meclizine).
Treatment Program
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physical therapy
occupational therapy
massage therapy
psychotherapy
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hypnotherapeutic relaxation training
eye movement desensitization
reprocessing
cognitive behavioral intervention techniques
independent pain management program
exercise program
Discussion
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There are similarity of many side effects
between alcohol and baclofen, possibly
because they both inhibit GABA ergic
transmission.
Both baclofen treatment and its withdrawal
increase depression, anxiety, PTSD, and
emotional states.
Seizures originating in the temporal lobe are
known to be accompanied by the jamais vu
phenomenon.
It appears that the only known factor
triggering this patient’s jamais vu episodes
was his use of baclofen.
Conclusion
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I report a case of a patient with jamais vu
episodes that appear to have been caused
by baclofen.
suggests that medications be considered as
a possible cause of jamais vu episodes