Paroxysmal sympathetic hyperactivity in brain damage (scientific review). Part 2

Currently, there is no generally accepted method for elimination of centrogenic hyperthermic reactions. In paroxysmal sympathetic hyperactivity, body temperature should be maintained in a safe normothermic range for at least the first few days. The potential benefits of treatment may result from three primary goals: elimination of triggering factors, mitigation of excessive sympathetic overload, and supportive therapy. Treatment involves reducing any external stimulation that can trigger paroxysmal episodes. Because fever is caused by a prostaglandin-induced shift in the hypothalamic “set point”, conventional nonsteroidal anti-inflammatory drugs inhibit prostaglandin synthesis, but centrogenic hyperthermic reactions are mostly resistant to antipyretic therapy. Physical cooling is used when medical treatment is ineffective. Endovascular cooling methods are more effective than external ones. Monotherapy for paroxysmal sympathetic hyperactivity is usually ineffective, so the possibility of using several drugs with different mechanisms of action should be considered. The use of moderate doses of several drug classes provides synergistic efficacy, reducing the toxicity of individual drugs. Multimodal treatment regimens are more effective than monotherapy. The lack of a generally accepted technique for elimination of centrogenic hyperthermic reactions requires further multicenter studies and the creation of appropriate clinical guidelines.