Pharmacological Treatment for Paroxysmal Sympathetic Hyperactivity

Area of Science:

• Neurology
• Critical Care Medicine
• Pharmacology

Background:

• Paroxysmal sympathetic hyperactivity (PSH) affects up to 10% of acquired brain injury survivors.
• PSH is characterized by autonomic dysregulation including elevated vital signs, diaphoresis, and posturing.
• Current management guidelines for PSH are limited despite its prevalence.

Observation:

• A literature review evaluated 10 studies (4 cohort, 5 case, 1 case series) on PSH pharmacological therapies.
• The objective was to identify best practices for managing PSH.
• Studies assessed various agents including opiates, GABAergic, dopaminergic, and beta-blockers.

Findings:

• Monotherapy is generally ineffective for PSH; combination therapy is recommended.
• Alpha-2 agonists (e.g., dexmedetomidine) may offer slight efficacy over propofol.
• Oral propranolol might be advantageous compared to other oral agents, though data is limited.

Implications:

• Critical care nurses are crucial for monitoring and managing PSH.
• Robust clinical trials are necessary to establish definitive PSH treatment protocols.
• Evidence-based guidelines are needed to optimize PSH patient outcomes.