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

¹ Brain Injury Rehabilitation Service, Westmead Hospital, Westmead NSW, Australia
² Brain Injury Unit, Hvidovre University Hospital, Hvidovre, Denmark
³ Rehabilitation Studies Unit, University of Sydney, Sydney, Australia

Correspondence to:
Correspondence to:
Dr Ian J Baguley
Brain Injury Rehabilitation Service, Westmead Hospital, PO Box 533, Wentworthville NSW 2145, Australia; ianb{at}biru.wsahs.nsw.gov.au

ABSTRACT
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.

Abbreviations: ANS, autonomic nervous system; ITB, intrathecal baclofen; TBI, traumatic brain injury