Use of Gabapentin for Paroxysmal Sympathetic Hyperactivity in Three Children with Severe Motor and Intellectual Disability due to Neonatal Hypoxic Ischemic Encephalopathy

Paroxysmal sympathetic hyperactivity (PSH) is a clinical syndrome characterized by recurrent episodes of sympathetic overactivity, including hypertonia, tachycardia, hypertension, and hyperthermia, typically following severe brain injury. While PSH is well documented in adult populations, reports on pediatric patients, particularly those with severe motor and intellectual disabilities (SMID), remain limited. Here, we report three pediatric patients with SMID due to neonatal hypoxic-ischemic encephalopathy (NHIE) who developed PSH. All patients presented with characteristic PSH symptoms and were diagnosed according to the Pediatric Clinical Practice Guidelines based on the 2014 consensus criteria. Gabapentin (GBP) was initiated at low doses (5-10 mg/kg/day) in all patients, resulting in the rapid resolution of PSH symptoms. In two patients, symptoms partially recurred within several months but were controlled through GBP dose adjustment and the addition of clonidine or other agents. No severe adverse events were observed. To our knowledge, this is the first report describing the short-term efficacy of GBP in pediatric patients who developed PSH with SMID status due to NHIE. Our findings suggest that GBP is a valuable and well-tolerated therapeutic option for the management of PSH in children with these conditions.