Paroxysmal Sympathetic Hyperactivity in Pediatric Rehabilitation : Pathological Features and Scheduled Pharmacological Therapies

Objective: Information on course and treatment of paroxysmal sympathetic hyperactivity (PSH) during rehabilitation and in pediatric patients is lacking. To increase knowledge on the course and treatment of PSH in pediatric patients during rehabilitation, we retrospectively analyzed 23 pediatric patients with PSH, describing the course of PSH and administered drugs, and explored the association of PSH remission with drug doses. Setting: Neurorehabilitation unit of IRCCS Eugenio Medea, Bosisio Parini (LC), Italy. Participants: Twenty-three pediatric patients with postacute acquired brain injury, who remitted from PSH. Design: Retrospective cohort study. Main Measures: Description of features and course of PSH, description of drug therapies, and analysis of covariance of their doses. Correlations between remission and drug doses/clinical variables. Estimation of the odds ratios of remission. Results: At admittance patients displayed at least 3 features of PSH with an overall score of 9, which diminished progressively during remission. Therapies with propranolol, baclofen, niaprazine, and diazepam were progressively uptitrated, indicating potential usefulness. When testing possible predictors of remission, we found positive effects of propranolol and diazepam and of traumatic etiology and a negative effect of maximum PSH severity. Conclusions: Results should be interpreted carefully regarding causal relationships and drug doses and combinations, but they encourage further studies on the use of propranolol and diazepam to favor PSH remission.