What are the treatment options for neurostorming?

From the Guidelines

Treatment of neurostorming should focus on controlling the autonomic nervous system overactivity, with first-line medications including beta-blockers, sedatives like benzodiazepines, and other agents to manage symptoms. The management of neurostorming, also known as paroxysmal sympathetic hyperactivity, involves a multimodal approach to control the symptoms. According to the study 1, the treatment involves primarily supportive care and removal of the initiating agent. However, in the context of neurostorming, the focus is on controlling the autonomic nervous system overactivity.

Key Treatment Options

• Beta-blockers like propranolol or labetalol to control tachycardia and hypertension
• Sedatives such as benzodiazepines to reduce agitation and sympathetic outflow
• Gabapentin or baclofen to manage muscle spasticity
• Opioids like morphine for severe episodes
• Clonidine to directly reduce sympathetic outflow For agitation, experts suggest benzodiazepines as the first-line agent, as mentioned in the study 1. Fever can be treated with external cooling measures.

Monitoring and Adjustment

Treatment should be initiated promptly when symptoms appear and requires close monitoring of vital signs. The underlying mechanism involves dysregulation of the autonomic nervous system following brain injury, with excessive release of catecholamines causing the characteristic symptoms. A multimodal approach is typically most effective, with medication adjustments based on symptom control.

From the Research

Treatment Options for Neurostorming

• Neurostorming, also known as sympathetic storming, is a life-threatening medical condition that requires immediate attention 2.
• The treatment options for neurostorming include the use of beta-blockers, such as propranolol, to reduce sympathetic activity and control hemodynamics 2, 3.
• Propranolol has been shown to be effective in reducing catecholamine levels, improving Glasgow Coma Scale (GCS) scores, and decreasing mortality in patients with traumatic brain injury (TBI) 2, 3.
• Other treatment options may include the use of sedatives, such as propofol and remifentanil, to control agitation and prevent further brain injury 4.
• Neuromuscular blocking agents (NMBAs) may also be used to control intracranial pressure (ICP) and prevent stimulation-related ICP surges 5.
• The choice of treatment option depends on the individual patient's condition and the underlying cause of the neurostorming 2, 3, 4, 5.

Medications Used to Treat Neurostorming

• Propranolol: a non-selective beta-blocker that has been shown to be effective in reducing sympathetic activity and controlling hemodynamics 2, 3.
• Propofol: a sedative that can be used to control agitation and prevent further brain injury 4.
• Remifentanil: an opioid analgesic that can be used to control pain and prevent further brain injury 4.
• Neuromuscular blocking agents (NMBAs): such as succinylcholine and atracurium, which can be used to control ICP and prevent stimulation-related ICP surges 5.

Important Considerations

• Early treatment is crucial in preventing further brain injury and improving outcomes 2, 3.
• The use of beta-blockers, such as propranolol, should be carefully considered in patients with TBI, as they may have a beneficial effect on outcomes 2, 3.
• The choice of sedative and analgesic medications should be carefully considered, as they may have different effects on ICP and cerebral hemodynamics 4.
• The use of NMBAs should be carefully considered, as they may have both positive and negative effects on ICP and patient outcomes 5.