Paroxysmal sympathetic hyperactivity: Current update on diagnosis, treatments, and outcomes.

Abstract

Background: Paroxysmal sympathetic hyperactivity (PSH) is a severe dysregulation of the sympathetic nervous system, often resulting from traumatic brain injury (TBI). With a prevalence of 10-30% in TBI patients, PSH poses diagnostic and therapeutic challenges. This study reviews advancements in diagnosis, management, and outcomes associated with PSH.

Methods: A comprehensive literature review of studies published in the past decade was conducted using PubMed, Scopus, Web of Science, and the Cochrane Library. Keywords included PSH, diagnostic criteria, treatment strategies, and clinical outcomes.

Results: The PSH Assessment Measure (PSH-AM), combining the clinical feature scale and diagnosis likelihood tool, enhances early detection and differentiates PSH from similar conditions. Acute management using opioids and benzodiazepines proved effective, while beta-blockers and alpha-2 agonists reduced episodic recurrence. Despite improved diagnostic accuracy, challenges persist, such as overlapping symptoms and difficulty quantifying autonomic dysfunction. PSH is associated with prolonged hospital stays and poorer neurological outcomes, emphasizing the importance of timely intervention.

Conclusion: Accurate diagnosis using tools like PSH-AM is essential for mitigating PSH-related complications. Future research should explore biomarkers and personalized therapies to refine diagnosis and optimize long-term outcomes through multicenter trials.