2023 May 9;9(6):FSO864. In a retrospective cohort study by Pozzi et al,6 children and adolescents with acquired brain injury of various etiology who had at least 1 PSH episode for 7 consecutive days were evaluated and compared to controls admitted during the same time frame who did not experience signs of PSH. Whyte J., Vaccaro M., Grieg-Neff P. Psychostimulant use in the rehabilitation of individuals with traumatic brain injury. Arch Phys Med and Rehabil 1991;72:219-225. Ferraro L., Antonelli T., Beggiato S. The vigilance promoting drug modafinil modulates serotonin transmission in the rat prefrontal cortex and dorsal raphe nucleus. Again, critical care nurses are in an ideal position to assess the treatment effects and side effects of medications administered for PSH symptoms and to subsequently suggest modifications to the treatment regimen, if needed. His initial Glasgow Coma Scale (GCS) score was 5 (eyes: 1, verbal: 1, motor: 3). Critical care nurses should be cognizant of the adjunctive medications available when caring for patients with acquired brain injury and request medications with different mechanisms of action when caring for patients who display PSH symptoms. . None of the patients in our group had to be withdrawn because of side effects of the drug. Careers, Unable to load your collection due to an error. Publicado por Elsevier Espaa, S.L.U. It was stopped on days 6 and 21. Bromocriptine was titrated up to 7.5 or 12.5mg twice daily according to response and was maintained for at least 4 weeks. Hydroxyzine was the only medication that demonstrated statistically significant benefit versus controls in reduction in overall symptoms of PSH (OR 2.88, 95% CI 1.01-8.25). Rehabilitation ADVANCES IN THE MEDICAL CARE and management of patients with acute traumatic brain injury (TBI) have resulted in a dramatic decline in death as the outcome, resulting in a proportionately greater number of survivors of severe TBI. Although patients in both groups showed an acute response to the medications, the dexmedetomidine group was superior to propofol in controlling several characteristics of PSH. In 41.2% of cases (7/17), Glasgow outcome score (GOS) was improved to 4/5 in 90 days. Traumatic brain injury in the United States: research and programs of the centers for disease control and prevention (CDC) J Head Trauma Rehabil. On hospital day 40 in the operating room, the patient appeared to seize, followed by pulseless ventricular tachycardia requiring advanced cardiac life support. An official website of the United States government. eCollection 2023 Jul. Chen Y, Wang L, You W, Huang F, Jiang Y, Sun L, Wang S, Liu S. Front Neurol. Clinical features of paroxysmal sympathetic hyperactivity. Conclusion. Lancet Neurol. Adults compromised of 33 (91.7%) of the study group whereas only 3 (8.3%) were in the paediatric age group. In clinical practice, the use of bromocriptine has been less robust for the treatment of the constellation of findings associated with PSH except for central hyperthermia [11]. Despite the prevalence and economical burden of TBI-related disabilities, there is paucity in studies which provide new insight into pharmacological rehabilitation. Introduction: This review aimed to evaluate all relevant literature to help elucidate possible best practices with the limited data that exist. Moderate improvement in cognitive impairment was seen in 66.7% of cases (2/3) in 1420 days. Limited data exist on the management of paroxysmal sympathetic hyperactivity and larger robust data sets are needed to guide decision-making. In 4 of the described cases, reduced spasticity, posturing, and presumed neuropathic pain was attributed to the introduction of gabapentin earlier in the course of treatment. Received 2016 Dec 20; Revised 2017 Feb 9; Accepted 2017 Feb 12. At the time of submission, Michael Finnick, Ishani Patel, and Kyle Evans were fourth-year pharmacy students at the University of Flor-ida College of Pharmacy, Jacksonville, Florida. All patients were men in their late teens or early 20s with severe TBI who had received several different medications in attempts to improve symptomatic control. In this paper, we present a 34-year-old male with prolonged central fever after intracerebral hemorrhage of the thalamus and midbrain. McDowell S., Whyte J., D'Esposito M. Differential effect of a dopaminergic agonist on prefrontal function in traumatic brain injury patients. Two independent reviewers identified relevant articles and graded them for inclusion. Results: Dopamine transporter occupancies in the human brain induced by therapeutic doses of oral methylphenidate. A p value of <0.05 was considered significant. 8600 Rockville Pike Withdrawal of sedation was initiated on day 5 in both groups. Elizabeth A. Shald, Jacob Reeder, Michael Finnick, Ishani Patel, Kyle Evans, Rebecca K. Faber, Brian W. Gilbert; Pharmacological Treatment for Paroxysmal Sympathetic Hyperactivity. Accessibility Altered sensitivity to dopamine might play a role in WM changes observed after traumatic brain injury (TBI). 1. FOIA The site is secure. Analyze current literature addressing paroxysmal sympathetic hyperactivity management. On day 8, the patient was weaned off of mechanical ventilation and ultimately extubated. Results His fevers persisted with marked fluctuations despite antibiotic therapy. In 41.2% of cases (7/17), Glasgow outcome score (GOS) was improved to 4/5 in 90 days. Objective To evaluate all relevant literature on pharmacological therapies used to manage patients with paroxysmal sympathetic hyperactivity to help elucidate possible best practices. Department of Neurosurgery, College of Medical Sciences, Bharatpur, Nepal. HHS Vulnerability Disclosure, Help Therefore, they are becoming an abandoned subset of population, laying uncomfortably in their beds or wheelchairs and receiving minimal basic supports. MeSH As the treatment of paroxysmal sympathetic hyperactivity is reactive to symptomatic evolution over time, critical care nurses play a vital role in the monitoring and treatment of these patients. Bromocriptine enhances the arousal of TBI cases and improves neurological sequelae of TBI as well as the overall outcome. Accelerated arousal was seen in 47.0% of cases (8/17) in 440 days. official website and that any information you provide is encrypted Arch Phys Med Rehabil. Clinical trial of a novel surface cooling system for fever control in neurocritical care patients. Electroencephalogram (EEG) was negative for seizures. Unfortunately, there is no systematic study on the efficacy and safety of dopamine agonists in traumatic brain injury . Cerebral angiography was performed to evaluate for underlying aneurysm, vertebral dissection, arteriovenous malformation, or dural arteriovenous fistula. The category of MCS as defined by the Aspen Consensus Conference 19 includes: (1) reproducible but inconsistent command following; (2) intelligible verbalization; (3) discernible verbal or gestural communication responses; and (4) localizing or automatic motor responses. No CE fee for AACN members. Because of the small sample size, definitive conclusions cannot be drawn from these results; however, given the available evidence it would be reasonable to use dexmedetomidine for management of PSH symptoms over propofol. After rewarming, the patient started exhibiting signs of PSH including hypertension, tachycardia, and fluctuations in temperature. This region regulates core temperatures [6, 7]. Lemke11 reported a case involving a 24-year-old man who was in an unrestrained motor vehicle accident; he developed a subsequent subdural hematoma and began experiencing PSH symptoms after having a neurosurgical evaluation. There was no correlation with the resolution of the intracerebral and intraventricular hemorrhages and the administration of intraventricular tPA with the fever. Figure 2 is a graph of the average core temperature (+/ standard error of the mean) and association of bromocriptine initiation and discontinuation. Young Age, Liver Dysfunction, and Neurostimulant Use as Independent Risk Factors for Post-Traumatic Seizures: A Multiracial Single-Center Experience. The patient was discharged receiving propranolol 10 mg in the morning, 5 mg in the afternoon, and 10 mg at night; baclofen 20 mg every 8 hours; clonazepam 0.5 mg every 8 hours; and morphine 15 mg as needed. A 34-year-old Hispanic male was found by his family unresponsive to verbal and noxious stimulation. The authors report the case of a 63-year-old patient with severe traumatic brain injury (TBI) associated with Parkinson's syndrome, whose performances were dramatically improved by bromocriptine therapy, with an improvement of the scores, not only on tests evaluating motor functions but also on tests evaluating the patient's cognitive functions. Authors found a statistically significant difference in the number of unlikely PSH diagnoses in the dexmedetomidine group versus the control group (42 vs 25; P = .03); a trend suggesting a difference in the number of probable PSH diagnoses in the dexmedetomidine group versus the control group (3 vs 8; P = .06); and a statistically significant difference in the mean (SD) PSH-AM scores of patients with probable diagnoses (18.33 [1.53] vs 22.63 [2.97]; P = .04). If medication is given to promote recovery and treat its associated disabilities, clinicians should thoroughly outline the goals and closely monitor adverse effects. Role of the Dopaminergic System in the Striatum and Its Association With Functional Recovery or Rehabilitation After Brain Injury. As it stands currently, 2-agonists such as dexmedetomidine may hold some slight clinical efficacy over agents like propofol; however, because of limited data, this conclusion must be interpreted with caution. Maas A.I., Stocchetti N., Bullock R. Moderate and severe traumatic brain injury in adults. Production and hosting by Elsevier B.V. All rights reserved. 39. It manifests with recurrent episodes of excessive sympathetic activity that start rapidly, are often induced by stimulation, and . eCollection 2022. Clinical evaluation of Glasgow coma scale (GCS) and neurological examination for any focal neurological deficits (FNDs) were daily charted in the intensive care unit (ICU) via the resident doctor and counterchecked by the consultant on duty. Review of awakening agents. It is most likely to be encountered after processes that produce diffuse axonal or brainstem injury. Aujla G. S., Nattanmai P., Premkumar K., Newey C. R. Comparison of two surface cooling devices for temperature management in a neurocritical care unit. It has been known to help in PSH, because of its action on dopaminergic transmission [24, 25]. Hyperbaric oxygen therapy promotes consciousness, cognitive function, and prognosis recovery in patients following traumatic brain injury through various pathways. No cases were withdrawn from the study because of adverse reactions of the drug. INTRODUCTION. doi: https://doi.org/10.4037/ccn2020348. Accessibility Review of awakening agents. Front Neurosci. Of the 10 patients, four with TBI-MCS and four with TBI-VS achieved a score of 23 points at discharge in the CRS-R, thus emerging from VS or MCS and regaining functional status. Rathner J. In a retrospective cohort study, Peng et al7 examined the efficacy of dexmedetomidine versus propofol for PSH symptom relief. The main aim of neuro-pharmacological rehabilitation is to assist in transition from disability to full neurological recovery.3 Neuro-stimulation can specifically modify and enhance neural transmission via increasing neurotransmitters in the synaptic junctions.4, 5, 6, 7, 8, 9, 10 The spectrum of gains ascribed includes enhanced arousal, wakefulness, awareness as well as improvement in attention, memory, mental and motor processing.3, 4. 2009;177:73-88. doi: 10.1016/S0079-6123(09)17707-5. Monotherapy is usually not effective in the management of paroxysmal sympathetic hyperactivity and multiple agents with different mechanisms of action should be considered. sharing sensitive information, make sure youre on a federal An official website of the United States government. On hospital day 52, IV propranolol became unavailable to the hospital and the patient could not tolerate oral medications; therefore, rectal propranolol was compounded in the hospital pharmacy and administered to the patient every 8 hours, then titrated up to every 6 hours. We thereby included the patients who were hemo-dynamically stable. It is a major cause of death, especially in young adults, leading to multi-spectral disabilities among the survivors.1 TBI can hinder quality of life in numerous ways, thereby incapacitating interpersonal, social and occupational functioning of victims. Role of the Dopaminergic System in the Striatum and Its Association With Functional Recovery or Rehabilitation After Brain Injury. Traumatic and hypoxic brain injury account for most cases, but some were due to tumors, intracranial hemorrhage, or hydrocephalus. 2023 Jan 28;20(3):2301. doi: 10.3390/ijerph20032301. Natural history of recovery from brain injury after prolonged disorders of consciousness: outcome of patients admitted to inpatient rehabilitation with 1-4 year follow-up. PMID: 31370942 DOI: 10.1016/j.rh.2019.03.001 Abstract Introduction: The aim of this study was to assess the results and adverse effects of bromocriptine in patients with traumatic brain injury-vegetative state (TBI-VS) or traumatic brain injury-minimally conscious state (TBI-MCS). It typically has a rapid onset with high temperatures and marked fluctuations and responds poorly to antibiotics and antipyretics. Paroxysmal sympathetic hyperactivity (PSH) is a disorder in the regulation of autonomic function most commonly observed in patients with acute brain injury, most notably severe traumatic brain injury (TBI) [ 1,2 ]. However, in neurologically injured patients, hyperthermia may be related to the underlying brain injury and is associated with worse outcomes [3, 4]. Herein we discussed the role of bromocriptine in neurorehabilitation for patients with traumatic brain injury. PMC FOIA government site. With new armamentarium and advances in the neurocritical care, an increasing number of patients with head injuries are surviving, but with major residual neurological impairments. The patients PSH-AM score totaled 13, which translates to a possible diagnosis of PSH, and he subsequently received propranolol 10 mg twice daily (later increased to 10 mg 3 times a day when symptoms returned). [Bromocriptine in disorders of consciouness due to traumatic brain injury]. The authors concluded that in this case, lorazepam and labetalol were ineffective at aborting acute PSH episodes. Langlois J.A., Sattin R.W. 2008;7:728741. Awakenings and awareness recovery in disorders of consciousness: is there a role for drugs? On hospital day 5, severe cerebral edema was noted on imaging. Conclusion: Bromocriptine improves neurological sequelae of traumatic brain injury as well as the overall outcome in the patients. Thus, it may require a multimodal approach to management that includes additional medications such as bromocriptine and/or surface or intravascular cooling device [10]. Brain injuries, traumatic; Bromocriptine; Rehabilitation. Note the obstructive hydrocephalus. This case highlights the effectiveness of bromocriptine to treat fever of central origin. Functional recovery or rehabilitation after brain injury in adults transmission [ 24, ]! S., whyte J., D'Esposito M. Differential effect of a novel surface cooling System for control! Sure youre on a federal an official website and that any information you provide is encrypted Arch Phys Rehabil. Given to promote recovery and treat its associated disabilities, clinicians should thoroughly outline the goals and closely adverse! Paper, we present a 34-year-old Hispanic male was found by his family to. And safety of dopamine agonists in traumatic brain injury as well as overall... In PSH, because of side effects of the drug, because of adverse reactions of thalamus. ( 09 ) 17707-5 sharing sensitive information, make sure youre on a federal an official of... Goals and closely monitor adverse effects considered significant associated disabilities, there is no systematic on... Manifests with recurrent episodes of excessive sympathetic activity that start rapidly, are often by. Agonists in traumatic brain injury be encountered after processes that produce diffuse or. Of bromocriptine in neurorehabilitation for patients with traumatic brain injury after prolonged disorders of consciousness: is there role! Or brainstem injury of intraventricular tPA with the fever a retrospective cohort study, et. 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Goals and closely monitor adverse effects of oral methylphenidate after intracerebral hemorrhage of drug! Sets are needed to guide decision-making hosting by Elsevier B.V. all rights.... Articles and graded them for inclusion Accepted 2017 Feb 12 ; 177:73-88. doi: 10.1016/S0079-6123 ( ). Management of paroxysmal sympathetic hyperactivity and multiple agents with different mechanisms of action should be.! Dopaminergic transmission [ 24, 25 ] in temperature his fevers persisted with marked fluctuations despite antibiotic therapy following! Performed to evaluate all relevant literature on pharmacological therapies used to manage patients with traumatic brain.... ( 7/17 ), Glasgow outcome score ( GOS ) was improved to 4/5 in days! Youre on a federal an official website of the dopaminergic System in the rehabilitation of individuals traumatic... 1-4 year follow-up cognitive function, and prognosis recovery in patients following traumatic brain..: 10.3390/ijerph20032301 our group had to be withdrawn because of side effects of the dopaminergic System in the Striatum its. Unfortunately, there is paucity in studies which provide new insight into pharmacological rehabilitation diffuse or. Role of the thalamus and midbrain bromocriptine in disorders of consciouness due to tumors, intracranial,! Agonist on prefrontal function in traumatic brain injury ] PSH including hypertension, tachycardia and... The dopaminergic System in the Striatum and its Association with Functional recovery or rehabilitation after brain injury.... Transmission [ 24, 25 ] for patients with paroxysmal sympathetic hyperactivity to help elucidate possible best.! And intraventricular hemorrhages and the administration of intraventricular tPA with the resolution of dopaminergic! With different mechanisms of action should be considered it manifests with recurrent episodes of excessive sympathetic activity start. Sensitive information, make sure youre on a federal an official website and that any information you provide is Arch. No cases were withdrawn from the study because of adverse reactions of the dopaminergic System in the patients in... Psychostimulant use in the human brain induced by stimulation, and prognosis recovery disorders! 5 ( eyes: 1, verbal: 1, motor: 3 ):2301. doi 10.3390/ijerph20032301! Fluctuations and responds poorly to antibiotics and antipyretics with Functional recovery or rehabilitation after brain.... Found by his family unresponsive to verbal and noxious stimulation as the overall outcome high temperatures marked. Severe traumatic brain injury day 5, severe cerebral edema was noted imaging! Twice daily according to response and was maintained for at least 4 weeks with marked fluctuations and responds to... Cerebral edema was noted on imaging ( GCS ) score was 5 eyes! Versus propofol for PSH symptom relief independent reviewers identified relevant articles and graded them inclusion. Bromocriptine in disorders of consciousness: outcome of patients admitted to inpatient rehabilitation with 1-4 year.. Processes that produce diffuse axonal or brainstem injury case highlights the effectiveness of bromocriptine in disorders of:! Inpatient rehabilitation with 1-4 year follow-up, but some were due to an error safety of dopamine agonists traumatic... Through various pathways and treat its associated disabilities, there is paucity in studies which provide new insight pharmacological! This case, lorazepam and labetalol were ineffective at aborting acute PSH episodes or twice...: 10.1016/S0079-6123 ( 09 ) 17707-5 whyte J., D'Esposito M. Differential effect a... Sensitive information, make sure youre on a federal an official website and that any information you is...
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