Early detection of PSH, such as after the onset of hypoxic encephalopathy or extensive brain injury, and systematic management before it becomes irreversible may reverse PSH [
19]. Clinical strategies for the management of PSH are divided into three main points: (1) reduction of stimulation, (2) reduction of sympathetic excitatory afferents, and (3) inhibition of the effects of sympathetic hyperactivity on target organs. Commonly used symptomatic medications include opioids, nonselective β-blockers, α2 agonists, bromocriptine, baclofen, gabapentin, and long-acting benzodiazepines, which are primarily used to lower body temperature, control heart rate, maintain blood pressure, sedate, and relieve spasticity or decrease muscle tone. There have also been case reports on the effectiveness of intrathecal baclofen [
29] and intrarectal administration [
30]. A previous study also found that trazodone was effective in reducing PSH symptoms following a left temporal lobe subcortical hemorrhage in a 49-year-old woman [
31]. In the retrieved case reports, the assessment of the effectiveness of PSH pharmacological treatments was mainly based on the reduction of sympathetic and motor hyperactivity events, with no quantitative data available for assessment, and the mechanisms by which these drugs improve PSH symptoms remain speculative. Daily PSH-AM score changes were monitored in only one case series to assess patient outcomes [
24]. As any stimulation that can trigger a PSH attack should be minimized, and sedation may be necessary. Isoproterenol is effective in controlling PSH symptoms; however, the use of some of these drugs remains controversial. A retrospective study in pediatric patients found that when drugs were administered during an acute episode of PSH, the most effective drugs were benzodiazepines, whereas analgesics had little effect. Another pediatric case study reported that morphine was most useful during acute exacerbations, especially for PSH, in which medications, such as propranolol, were ineffective, and that the dose of morphine need not be increased incrementally [
32].
Monotherapy for PSH has been inconsistently reported, with some studies suggesting that monotherapy is ineffective for PSH [
33]; however, some cases have reported the effectiveness of monotherapy, such as propranolol [
34], which is often used as the first choice for PSH. In clinical practice, combination medications are used in most cases; for example, the combination of guanfacine with gabapentin is safe and effective [
35]. Combination therapy using dexmedetomidine and propranolol is widely used [
36]. Optimizing the efficacy of these medications and reducing their side effects are the goals and challenges faced by clinical medications. Propranolol and dextromethorphan treat PSH in the acute phase and have prophylactic effects [
37]. Other reports have stated that dextromethorphan can only be used for treatment and has no preventive effects [
38]. This finding suggests that further studies are required to standardize the clinical use of medications for the treatment of PSH. Over time, patients with PSH may develop secondary complications, including dehydration, electrolyte disturbances, malnutrition, and muscle wasting. Hydration and nutrition should be adjusted to compensate for the increased fluid loss and metabolic demands.