PSH management

Paroxysmal Sympathetic Hyperactivity after acquired brain injury; overstimulation secondary to TBI

Treatment strategies target the inhibition of central sympathetic output, afferent sensory input, and effector organ responses to sympathetic stimulation.

1. adrenergic agonists | Dexmedetomidine, clonidine; used to control central and peripheral adrenergic activities
2.  non selective b-blockers | Propranolol is a lipophilic, central inhibition of catecholamine release, reduce metabolic rates
3. aminobutyric acid receptor class A (GABAA) agonists, propofol and midazolam
4. GABAB agonists | baclofen
5. dopamine agonists Bromocriptine, considered useful when dystonia or severe posturing persists
6. calcium channel blockers |  dantrolene, considered useful when dystonia or severe posturing persists
7.  anesthetics/opiates
8.  benzodiazepines
9. histamine antagonists

 Monotherapies are thought to be ineffective for PSH management, so multiple agents with different modes of action are commonly used in combination.

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