1201 - A case of acute mania in Adult onset X Linked Adrenoleukodystrophy after baclofen pump removal and withdrawal: A case report

67 year old male with adult onset X Linked adrenoleukodystrophy and spastic paraplegia. Underwent baclofen pump replacement on 09/06/23 which was then complicated by infection and baclofen pump removal on 10/11/23. He then was admitted to acute inpatient rehabilitation for further management of baclofen withdrawal and mobility training from 10/16-10/27. During acute inpatient rehabilitation, stay was complicated by continued baclofen withdrawal which was managed with the addition of diazepam. Then on 10/25 he was noted to have grandiose, pressured speech, decreased sleep, and increased impulsivity. Psychiatry was consulted and recommended starting Seroquel for acute mania. Upon discharge he initially returned home then was transferred to SNF for further management of acute mania, baclofen withdrawal, and spasticity management.

Discussions: To the best of our knowledge, this is the first reported case of baclofen withdrawal complicated by acute mania in a patient with adult onset X Linked adrenoleukodystrophy.

Conclusions: In addition to baclofen withdrawal, acute mania is an important complication to consider in patients who undergo baclofen pump removal.