Leg Mobility Issues and Onset of Hand Spasticity
A 20-year-old female with a medical history of grade II right and grade IV left brain hemorrhages, characterized by intraventricular hemorrhaging, alongside spastic diplegia due to cerebral palsy. She has a baclofen pump that was implanted last August at the T-7 catheter level and does not have a shunt.
Recently, over the span of about six weeks, she has been struggling to mobilize her legs, with instances of complete numbness and paralysis. Moreover, she has experienced sudden and severe spasticity in her hands, a condition she has not previously encountered, significantly hampering her daily activities and prompting a return to occupational therapy.
A couple of weeks back, she visited the emergency room, where the stress attributed to her college studies was suggested as a potential cause, leading to the prescription of diazepam. Three days post-visit, her baclofen dosage was adjusted upwards from 164 mcg to 188.9 mcg — an increase of 15%. Shortly after this adjustment during occupational therapy, she encountered a distressing episode characterized by difficulty in speech, resembling a cognitive jumble of words; her usual boisterousness was replaced by a muffled whisper. Although her blood pressure readings remained within a standard range, she lost control over her limbs and felt disoriented; notably, she had taken a diazepam tablet the night before.
Following this, she returned to the ER, where MRIs of her brain and spinal cord, along with x-rays, showed normal results, apart from some early signs of juvenile degenerative disk disease beginning at T-7 and extending to T-12.
Just yesterday, she experienced another similar incident while attempting to grip a pen, discovering that her arm had become immobile. She was unable to read simple inquiries, maintain her head or trunk position, and was slumped to one side in her wheelchair. Her speech slowed significantly, accompanied by the same jumbled expression as before, while her blood pressure readings were slightly low, with a normal systolic figure. Additionally, she noted tachycardia readings between 120 to 140 beats per minute as assessed by her Apple Watch. Fortunately, during a recent neurosurgery consultation, her baclofen pump was adjusted down to the 160 mcg range, which was suspected to address some of her problems.
The two distressing episodes were observed two weeks apart, occurring around the same time in the afternoon. She had taken oral baclofen between episodes without experiencing any issues, and she ceased taking diazepam after the initial incident.
Investigations confirmed that the pump is functioning correctly, and the catheter is neither kinked nor misplaced. The appropriate medication dosage was withdrawn yesterday, indicating that an overdose was unlikely. Could the challenges in leg movement and the emergence of hand spasticity be interconnected with the recurrent episodes she's been facing? Are these occurrences potentially attributable to excessive medication, or could they stem from an alternative cause?