title: Pharmacological management of Dysautonomia following traumatic brain injury.
abstract: 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.
authors.affiliation: Brain Injury Rehabilitation Service, Westmead Hospital, Wentworthville, NSW, Australia. ianb@biru.wsahs.nsw.gov.au
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Baguley
authors.forename: Ian D
authors.initials: ID
authors.lastname: Cameron
authors.forename: Alisa M
authors.initials: AM
authors.lastname: Green
authors.forename: Shameran
authors.initials: S
authors.lastname: Slewa-Younan
authors.forename: Jeno E
authors.initials: JE
authors.lastname: Marosszeky
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Gurka
mesh_terms: 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
chemical_list: D018377:Neurotransmitter Agents; D009020:Morphine; D008874:Midazolam; D002746:Chlorpromazine