Spasticity management and resolution of paroxysmal sympathetic hyperactivity in the acute care setting: a case series

ABSTRACT

Objective

The aim is to highlight three cases of focal spasticity and/or dystonia as potential noxious triggers and treatment targets of Paroxysmal Sympathetic Hyperactivity (PSH).

Methods

We review the literature, explore pathophysiology, and review treatment options. We discuss the clinical course and management of three unique patients who presented to a teaching hospital with severe traumatic brain injury (TBI) complicated by PSH managed by a physiatry consult team.

Results

Three patients, ranging in age from 8 months to 27 years, were admitted with severe TBI complicated by PSH refractory to pharmacologic management. All three patients, however, had resolution of PSH within 24-72 hours of focal spasticity treatments (i.e. casting and botulinum toxin injections).   

Conclusion

PSH is a constellation of physiologic findings and physical symptoms that is incompletely understood. Management is based on addressing predominant symptom features and physiologic responses. In certain cases, ongoing spasticity and/or dystonia may serve as noxious stimuli for persistence of PSH in moderate to severe brain injury. As such, the focal treatment of spasticity and/or dystonia may be considered as a treatment target in the management of refractory PSH.

KEYWORDS:

• traumatic brain injury
• trauma
• rehabilitation
• spasticity
• paroxsymal sympathetic hyperactivity
• storming

Disclosure statement

Arline Edmond has nothing to disclose. Ondrea McKay has nothing to disclose. Natasha Mehta has nothing to disclose. Laurie Dabaghian has nothing to disclose. Peter Yonclas has nothing to disclose. There were no funds or grants used for this work. There is no financial benefit to any of the authors. The work in this manuscript was not previously presented in any form and is not under consideration for publication in another journal. All the authors have contributed to the writing of this manuscript.

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.