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March 8, 2016Journal of Neuroscience Nursing

Pharmacologic Management of Paroxysmal Sympathetic Hyperactivity After Brain Injury

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Why the study?

What are the common medications and strategies used in the pharmacologic management of paroxysmal sympathetic hyperactivity after brain injury?

Population

Patients with paroxysmal sympathetic hyperactivity (PSH) after acute brain injury

Design

Review

Key result

A combination of medications from different classes, including symptom-abortive and preventive agents, appears to be the most effective approach in managing paroxysmal sympathetic hyperactivity.

Authors

SSSophie SamuelTATeresa A. AllisonKLKiwon Lee

Discussion

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Overview

May support combined abortive and preventive agents for paroxysmal sympathetic hyperactivity; leaves open validation in prospective trials.

Key Points

  • This review aims to summarize pharmacologic management options for paroxysmal sympathetic hyperactivity (PSH) after brain injury.
  • Reviewed case reports and series on pharmacotherapy for PSH
  • Discussed medications used for symptom abortion and prevention
  • Identified issues with dosing and duration of therapy in clinical practice
  • Common medications include opioids, benzodiazepines, and β-blockers for symptom control.
  • Variability exists in drug choices, dosing regimens, and treatment durations among clinicians.
  • A combined approach using various drug classes shows the most effectiveness in managing PSH symptoms.

Structured PICO

What are the common medications and strategies used in the pharmacologic management of paroxysmal sympathetic hyperactivity after brain injury?

P
Population
Patients with paroxysmal sympathetic hyperactivity (PSH) after acute brain injury
I
Intervention
Pharmacologic management including symptom-abortive medications (morphine, short-acting benzodiazepines) and preventive/refractory medications (long-acting benzodiazepines, nonselective β-blockers, α2 agonists, opioids, and GABA agonists)
O
Outcome
Symptom abortion, prevention of symptoms, and refractory treatment

Pharmacologic management of paroxysmal sympathetic hyperactivity after brain injury relies heavily on anecdotal evidence, with a combination of medication classes appearing most effective for symptom control.

Limitations

  • Evidence for management is almost entirely anecdotal
  • Data describing drug choices, dosing, and duration of therapy are sparse
  • Wide variability in clinical practice
  • Sparse data describing drug choices, dosing, and duration of therapy

Cite This Study

Samuel et al. (2016) conducted a review in Paroxysmal sympathetic hyperactivity (PSH) after brain injury. Pharmacologic management was evaluated. A combination of medications from different classes, including symptom-abortive and preventive agents, appears to be the most effective approach in managing paroxysmal sympathetic hyperactivity.

synapsesocial.com/papers/6a20808d27dc97a0e8cd413chttps://doi.org/10.1097/jnn.0000000000000207
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Paroxysmal sympathetic hyperactivity after acquired brain injury: A review of diagnostic criteria2011 · 104 citations
  2. 2Morphine-Sensitive Paroxysmal Sympathetic Storm in Pontine Intracerebral Hemorrhage2010 · 23 citations
  3. 3Treatment of paroxysmal sympathetic storm with labetalol2000 · 67 citations
  4. 4Dysautonomia and heart rate variability following severe traumatic brain injury2006 · 141 citations
  5. 5Paroxysmal Sympathetic Hyperactivity after Acquired Brain Injury: Consensus on Conceptual Definition, Nomenclature, and Diagnostic Criteria2014 · 354 citations