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  Introduction  Case Description  Discussion  Conclusion

Introduction

Jamais Vu  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

 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  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  drowsiness  confusion  sedation  memory and attention problems  depression  euphoria  hallucinations of auditory, olfactory, and visual types

Case Description

Patient  37-year-old slightly obese man who was involved in a motor vehicle crash (MVC)  Smoke, Alcoholic drink.

診斷 (1)  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)  concussion syndrome  benign positional vertigo  left neck and shoulder girdle myofascial pain syndrome  mild left CTS  mild left cubital tunnel syndrome  PTSD.

Medications  (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  (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  physical therapy  occupational therapy  massage therapy  psychotherapy  hypnotherapeutic relaxation training  eye movement desensitization  reprocessing  cognitive behavioral intervention techniques  independent pain management program  exercise program

Discussion

 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  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