title: Paroxysmal Sympathetic Hyperactivity in Pediatric Rehabilitation: Clinical Factors and Acute Pharmacological Management.
abstract: OBJECTIVE
  Paroxysmal sympathetic hyperactivity (PSH) is widely described as occurring during intensive care, but in a number of patients it may last longer into the rehabilitation phase. Furthermore, drug therapy has been based on isolated observations. In this study, our aims are to describe a group of 26 pediatric rehabilitation patients with PSH and to quantify the effect of several drugs used to suppress PSH episodes.
  
  
  METHODS
  Neurorehabilitation unit of IRCCS Eugenio Medea, Bosisio Parini (LC), Italy.
  
  
  METHODS
  A total of 407 pediatric patients with postacute acquired brain injury, 26 of which had PSH.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Descriptive demographic and clinical data. Odds ratios quantification of the efficacy of drug therapies administered acutely to suppress PSH episodes.
  
  
  RESULTS
  PSH was associated with a longer duration of coma and a greater incidence of death. When administered acutely to suppress PSH episodes, the best drugs were clonazepam, hydroxyzine, and delorazepam, while analgesic drugs showed little efficacy.
  
  
  CONCLUSIONS
  PSH, whether causative or not, is associated with a worse long-term course in rehabilitation. Clinical management of PSH may be helped by a number of acutely administered drug therapies.
authors.affiliation: Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy (Drs Pozzi, Locatelli, Galbiati, Clementi, and Strazzer); Regional Centre for Pharmacovigilance of Lombardy, Milan, Italy (Dr Conti); Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, Milan, Italy (Dr Radice); Neuroreanimation, AO San Gerardo, Monza, Italy (Dr Citerio); Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, Milan, Italy (Dr Clementi) M.P. and V.C. contributed equally to the work.
authors.forename: Marco
authors.initials: M
authors.lastname: Pozzi
authors.forename: Valentino
authors.initials: V
authors.lastname: Conti
authors.forename: Federica
authors.initials: F
authors.lastname: Locatelli
authors.forename: Sara
authors.initials: S
authors.lastname: Galbiati
authors.forename: Sonia
authors.initials: S
authors.lastname: Radice
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Citerio
authors.forename: Emilio
authors.initials: E
authors.lastname: Clementi
authors.forename: Sandra
authors.initials: S
authors.lastname: Strazzer
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000293:Adolescent; D000553:Ambulatory Care / Q000379:methods; D001342:Autonomic Nervous System Diseases / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D001569:Benzodiazepines / Q000627:therapeutic use; D001930:Brain Injuries / Q000150:complications* / Q000523:psychology* / Q000534:rehabilitation; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002998:Clonazepam / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006948:Hyperkinesis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D015601:Injury Severity Score; D007558:Italy; D008297:Male; D000066530:Neurological Rehabilitation / Q000379:methods*; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D001569:Benzodiazepines; D000082:Acetaminophen; D002998:Clonazepam