Gabapentin in the management of dysautonomia following severe traumatic brain injury: a case series

The pharmacological management of dysautonomia, otherwise known as autonomic storms, following acute neurological insults, is problematic and remains poorly researched. This paper presents six subjects with dysautonomia following extremely severe traumatic brain injury where gabapentin controlled paroxysmal autonomic changes and posturing in the early post-acute phase following limited success with conventional medication regimens. In two subjects, other medications were reduced or ceased without a recurrence of symptoms. It is proposed that medications that can block or minimise abnormal afferent stimuli may represent a better option for dysautonomia management than drugs which increase inhibition of efferent pathways. Potential mechanisms for these effects are discussed.

[1]  G. Clifton,et al.  Assessment of nutritional requirements of head-injured patients. , 1986, Journal of neurosurgery.

[2]  I. Baguley,et al.  Dysautonomia after traumatic brain injury: a forgotten syndrome? , 1999, Journal of neurology, neurosurgery, and psychiatry.

[3]  G. Francisco,et al.  Intrathecal baclofen therapy for spastic hypertonia. , 2001, Physical medicine and rehabilitation clinics of North America.

[4]  K. Nicholson.  Pain, cognition and traumatic brain injury. , 2000, NeuroRehabilitation.

[5]  E. Cuny,et al.  Dysautonomia syndrome in the acute recovery phase after traumatic brain injury: relief with intrathecal Baclofen therapy , 2001, Brain injury.

[6]  L. J. Horn,et al.  Hypertension after brain injury: case report. , 1986, Archives of physical medicine and rehabilitation.

[7]  K. Lee,et al.  Gabapentin inhibits high‐threshold calcium channel currents in cultured rat dorsal root ganglion neurones , 2002, British journal of pharmacology.

[8]  B. Scheithauer,et al.  Temperature Changes of greater or equal to 1 degree Celsius Alter Functional Neurologic Outcome and Histopathology in a Canine Model of Complete Cerebral Ischemia , 1995 .

[9]  R A Bryant,et al.  Incidence of chronic pain following traumatic brain injury. , 1996, Archives of physical medicine and rehabilitation.

[10]  G. Roeste,et al.  A clinical study of intrathecal baclofen using a programmable pump for intractable spasticity. , 2005, Archives of physical medicine and rehabilitation.

[11]  R. Russo,et al.  Bromocriptine for the management of autonomic dysfunction after severe traumatic brain injury , 2000, Journal of paediatrics and child health.

[12]  B. Boeve,et al.  Paroxysmal sympathetic storms ("diencephalic seizures") after severe diffuse axonal head injury. , 1998, Mayo Clinic proceedings.

[13]  S. Slewa-Younan,et al.  Pharmacological management of Dysautonomia following traumatic brain injury , 2004, Brain injury.

[14]  P. Kam,et al.  Gabapentin: pharmacology and its use in pain management , 2002, Anaesthesia.

[15]  Prolonged anti-spasticity effects of bolus intrathecal baclofen , 2005, Brain injury.

[16]  M. Backonja,et al.  Anticonvulsants for neuropathic pain syndromes: mechanisms of action and place in therapy. , 2000, Drugs.

[17]  S. Borosky,et al.  Inhibition of K+-evoked glutamate release from rat neocortical and hippocampal slices by gabapentin , 2000, Neuroscience Letters.

[18]  Steven P. Cohen,et al.  Pain Management in Trauma Patients , 2004, American journal of physical medicine & rehabilitation.

[19]  D. Hellwig,et al.  Intrathecal baclofen alleviates autonomic dysfunction in severe brain injury , 2000, Journal of clinical neuroscience.

[20]  Peter A. Smith.  Neuropathic pain: drug targets for current and future interventions. , 2004, Drug news & perspectives.

[21]  R. Dempsey,et al.  Altered gastric emptying in the head-injured patient: relationship to feeding intolerance. , 1991, Journal of neurosurgery.

[22]  R. Penn,et al.  Intrathecal baclofen down-regulates GABAB receptors in the rat substantia gelatinosa. , 1993, Journal of neurosurgery.

[23]  D. Lemke.  Riding out the storm: sympathetic storming after traumatic brain injury. , 2004, The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses.

[24]  B. Siesjö,et al.  The effect of mild hyperthermia and hypothermia on brain damage following 5, 10, and 15 minutes of forebrain ischemia , 1990, Annals of neurology.

[25]  B. Scheithauer,et al.  Temperature changes of > or = 1 degree C alter functional neurologic outcome and histopathology in a canine model of complete cerebral ischemia. , 1995, Anesthesiology.

[26]  R. Albrecht,et al.  Occurrence of potentially detrimental temperature alterations in hospitalized patients at risk for brain injury. , 1998, Mayo Clinic proceedings.

[27]  G. E. Holmes,et al.  Autonomic dysfunction associated with locked-in syndrome in a child. , 1997, American journal of physical medicine & rehabilitation.

[28]  Jen-Kun Cheng,et al.  Mechanisms of the antinociceptive action of gabapentin. , 2006, Journal of pharmacological sciences.

[29]  R G Hill,et al.  Actions of the GABAB agonist, (−)‐baclofen, on neurones in deep dorsal horn of the rat spinal cord in vitro , 1989, British journal of pharmacology.