Pharmacological management of Dysautonomia following traumatic brain injury.
OBJECTIVE
To document and critically evaluate the likely effectiveness of pharmacological treatments used in a sample of patients with Dysautonomia and to link these findings to previously published literature.


METHODS
Retrospective case control chart review.


METHODS
Data were collected on age, sex and GCS matched subjects with and without Dysautonomia (35 cases and 35 controls). Data included demographic and injury details, physiological parameters, medication usage, clinical progress and rehabilitation outcome. Descriptive analyses were undertaken to characterize the timing and frequency of CNS active medications.


RESULTS
Dysautonomic patients were significantly more likely to receive neurologically active medications. A wide variety of drugs were utilised with the most frequent being morphine/midazolam and chlorpromazine. Cessation of morphine/midazolam produced significant increases in heart rate and respiratory rate but not temperature. Chlorpromazine may have modified respiratory rate responses, but not temperature or heart rate.


CONCLUSIONS
The features of Dysautonomia are similar to a number of conditions treated as medical emergencies. Despite this, no definitive treatment paradigm exists. The best available evidence is for morphine (especially intravenously), benzodiazepines, propanolol, bromocriptine and possibly intrathecal baclofen. Barriers to improving management include the lack of a standardized nomenclature, formal definition or accepted diagnostic test. Future research needs to be conducted to improve understanding of Dysautonomia with a view to minimizing disability.
Baguley
Ian J
IJ
Brain Injury Rehabilitation Service, Westmead Hospital, Wentworthville, NSW, Australia. ianb@biru.wsahs.nsw.gov.au
Cameron
Ian D
ID
Green
Alisa M
AM
Slewa-Younan
Shameran
S
Marosszeky
Jeno E
JE
Gurka
Joseph A
JA
D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D001930:Brain Injuries / Q000150:complications* / Q000503:physiopathology; D016022:Case-Control Studies; D002746:Chlorpromazine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D009020:Morphine / Q000627:therapeutic use; D018377:Neurotransmitter Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D013997:Time Factors
D018377:Neurotransmitter Agents; D009020:Morphine; D008874:Midazolam; D002746:Chlorpromazine