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Gabapentin in the management of dysautonomia following severe traumatic brain injury: a case series
  1. Ian J Baguley1,
  2. Roxana E Heriseanu1,
  3. Joseph A Gurka1,
  4. Annette Nordenbo2,
  5. Ian D Cameron3
  1. 1Brain Injury Rehabilitation Service, Westmead Hospital, Westmead NSW, Australia
  2. 2Brain Injury Unit, Hvidovre University Hospital, Hvidovre, Denmark
  3. 3Rehabilitation Studies Unit, University of Sydney, Sydney, Australia
  1. 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.

  • ANS, autonomic nervous system
  • ITB, intrathecal baclofen
  • TBI, traumatic brain injury

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Footnotes

  • Competing interests: None.

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