Abstract Details

Title A National Survey Describing Management Patterns for Pediatric Paroxysmal Sympathetic Hyperactivity (PSH)

Topic Child Neurology and Developmental Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 8-001

Objective To describe current trends in pharmacologic management of paroxysmal sympathetic hyperactivity (PSH) among pediatric physicians practicing in North America.

Background

Paroxysmal sympathetic hyperactivity (PSH), frequently referred to as dysautonomia and “storming,” is a common source of discomfort among patients with severe neurological impairment. Despite more than 20 classes of medications being described in the literature to treat PSH, there are currently no studies that broadly describe utilization patterns among pediatric clinicians and recommendations rely on expert opinion.

Design/Methods From March through August 2023, attending physicians from multiple pediatric disciplines were invited to complete a one-time, web-based survey via Qualtrics. Participants reported their comfort levels in managing PSH, treatment preferences for abortive and maintenance PSH management, and the subspecialties responsible for managing PSH at their institution. Descriptive statistics were calculated; subgroup analyses were conducted using Chi-squared and Fisher’s exact tests.

Results Of 295 respondents, 33% were palliative care physicians, 23% were neurologists, 18% were complex care specialists, and 17% were physiatrists. The majority (76%) of respondents felt very/somewhat comfortable managing pediatric PSH. The pediatric subspecialty primarily responsible for inpatient PSH management varied significantly by institution: physiatry (32%), neurology (26%), critical care medicine (15%), palliative care (4%), and general pediatrics (3%). The most frequently used abortive medications were GABA-A agonists (e.g., lorazepam) (85.7%) and alpha-2 agonists (e.g., clonidine) (78.6%). The most used maintenance medications were alpha-2 agonists (89.6%) and gabapentinoids (88.6%). Notably, use of opioid, alpha-2 agonist, and dopamine agonist medications varied significantly for both abortive (p<0.01) and maintenance (p<0.05) management of PSH across pediatric subspecialties.

Conclusions Significant heterogeneity in pharmacologic management of pediatric PSH exists, especially across subspecialists. Future work comparing efficacy of pediatric PSH management strategies is needed to improve best-practice recommendations.

Authors/Disclosures
Hitoshi Koshiya, MD PRESENTER	Dr. Koshiya has nothing to disclose.
Laura A. Kirkpatrick, MD (UPMC Children's Hospital of Pittsburgh)	The institution of Dr. Kirkpatrick has received research support from Child Neurologist Career Development Program. The institution of Dr. Kirkpatrick has received research support from Child Neurology Foundation. The institution of Dr. Kirkpatrick has received research support from Rosenau Family Research Foundation. The institution of Dr. Kirkpatrick has received research support from Society of Family Planning. The institution of Dr. Kirkpatrick has received research support from Pediatric Epilepsy Research Consortium. The institution of Dr. Kirkpatrick has received research support from NINDS. The institution of Dr. Kirkpatrick has received research support from PCORI. The institution of Dr. Kirkpatrick has received research support from American Board of Psychiatry and Neurology. Dr. Kirkpatrick has received personal compensation in the range of $0-$499 for serving as a Grant reviewer with Society of Family Planning. Dr. Kirkpatrick has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Norton Children's Hospital. Dr. Kirkpatrick has a non-compensated relationship as a Board of Directors member with My Epilepsy Story that is relevant to AAN interests or activities.
Alyssa Zuziak	No disclosure on file
Julie Hauer	No disclosure on file
Justin Yu (UPMC Children's Hospital of Pittsburgh)	No disclosure on file

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