Decreasing incidence of paroxysmal sympathetic hyperactivity syndrome in the vegetative state.

OBJECTIVE To update knowledge of the incidence of paroxysmal sympathetic hyperactivity (PSH, also referred to as dysautonomia), an emergency condition tentatively attributed to sympathetic paroxysms or diencephalic-hypothalamic disarrangement associated with severe diffuse brain axonal damage or hypoxia. This condition is reportedly common in the vegetative state, threatens survival and affects outcome. METHODS The results of a retrospective study on 333 subjects in a vegetative state admitted to a dedicated unit in 1998-2005 are compared with a survey on patients admitted to the same unit in 2006-2010. RESULTS AND COMMENT In the 1998-2005 period, the incidence of PSH was 32% and 16% in post-traumatic and non-traumatic patients, respectively. It decreased to 18% and 7% in the 2006-2010 period. The PSH duration and the time spent in emergency units before admission and in the dedicated unit for the vegetative state after admission also decreased significantly. Incidence was greater among post-traumatic- patients; its effect on outcome does not appear to have changed.

[1]  J. Giacino,et al.  The Vegetative and Minimally Conscious States: A Comparison of Clinical Features and Functional Outcome , 1997 .

[2]  G. B. Young,et al.  Prognostic Determination in Anoxic-Ischemic and Traumatic Encephalopathies , 2004, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[3]  F. Plum,et al.  Persistent vegetative state after brain damage. A syndrome in search of a name. , 1972, Lancet.

[4]  B Jennett,et al.  Assessment of outcome after severe brain damage. , 1975, Lancet.

[5]  I. Baguley,et al.  Dysautonomia and heart rate variability following severe traumatic brain injury , 2006, Brain injury.

[6]  W. Talman,et al.  A hyperthermic syndrome in two subjects with acute hydrocephalus. , 1988, Archives of neurology.

[7]  M. Bailey,et al.  The functional outcome of patients requiring over 28 days of intensive care: a long-term follow-up study. , 2006, Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine.

[8]  E. Wijdicks.  Clinical scales for comatose patients: the Glasgow Coma Scale in historical context and the new FOUR Score. , 2006, Reviews in neurological diseases.

[9]  M Rappaport,et al.  Disability rating scale for severe head trauma: coma to community. , 1982, Archives of physical medicine and rehabilitation.

[10]  E. Benarroch.  Paroxysmal Sympathetic Storms , 2009 .

[11]  B. Jennett.  The vegetative state , 2002, Journal of neurology, neurosurgery, and psychiatry.

[12]  S. Slewa-Younan,et al.  Diagnosing dysautonomia after acute traumatic brain injury: evidence for overresponsiveness to afferent stimuli. , 2009, Archives of physical medicine and rehabilitation.

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

[14]  L. Sazbon,et al.  Loewenstein communication scale for the minimally responsive patient , 2002, Brain injury.

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

[16]  H. Hendricks,et al.  Dysautonomia after severe traumatic brain injury , 2010, European journal of neurology.

[17]  Orthostatic circulatory disorders in early neurorehabilitation: A case report and management overview , 2007, Brain injury.

[18]  Thomas A Gennarelli,et al.  Mechanisms and pathophysiology of cerebral concussion , 1986 .

[19]  I. Baguley.  The excitatory:inhibitory ratio model (EIR model): An integrative explanation of acute autonomic overactivity syndromes. , 2008, Medical hypotheses.

[20]  A. Hijdra,et al.  Systematic review of prediction of poor outcome in anoxic-ischaemic coma with biochemical markers of brain damage , 2001, Intensive Care Medicine.

[21]  N. Dafny,et al.  SEROTONIN MODULATES HYPOTHALAMIC NEURONAL ACTIVITY , 2004, The International journal of neuroscience.

[22]  B Jennett,et al.  Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. , 1981, Journal of neurology, neurosurgery, and psychiatry.

[23]  J. Giacino,et al.  Predictors of outcome in prolonged posttraumatic disorders of consciousness and assessment of medication effects: A multicenter study. , 2005, Archives of physical medicine and rehabilitation.

[24]  D. Kerr,et al.  Clinical potential of GABAB receptor modulators. , 2006, CNS drug reviews.

[25]  A. Rabinstein.  Paroxysmal sympathetic hyperactivity in the neurological intensive care unit , 2007, Neurological research.

[26]  J. Halter,et al.  Autonomic epilepsy: clonidine blockade of paroxysmal catecholamine release and flushing. , 1978, Annals of internal medicine.

[27]  S. Slewa-Younan,et al.  A Critical Review of the Pathophysiology of Dysautonomia Following Traumatic Brain Injury , 2008, Neurocritical care.

[28]  B. Jennett,et al.  ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE A Practical Scale , 1975, The Lancet.

[29]  V. Lagani,et al.  Dysautonomia and Clinical Outcome in Vegetative State. , 2008, Journal of neurotrauma.

[30]  J. Giacino,et al.  The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. , 2004, Archives of physical medicine and rehabilitation.

[31]  Walter G Sannita,et al.  Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome , 2010, BMC medicine.

[32]  I. Baguley.  Nomenclature of "paroxysmal sympathetic storms". , 1999, Mayo Clinic proceedings.

[33]  David K Menon,et al.  A review of paroxysmal sympathetic hyperactivity after acquired brain injury , 2010, Annals of neurology.

[34]  W. Sannita,et al.  The Glasgow outcome scale in vegetative state: A possible source of bias , 2009, Brain injury.

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

[36]  J. Giacino,et al.  The vegetative and minimally conscious states. , 2008, Handbook of clinical neurology.