Current Content
Volume 45 - Number 2
March/April 2019

Differentiating Paroxysmal Sympathetic Hyperactivity from Seizures in Medically Complex Children
Mark Timothy Bleazard

Background: Paroxysmal sympathetic hyperactivity and seizures may co-occur in the medically complex child with autonomic instability. Distinguishing one from the other can be difficult for the clinician due to an overlap in presentation. As a result, signs of paroxysmal sympathetic hyperactivity are frequently misinterpreted as seizures, leading to delays in appropriate care.

Purpose: To provide nurses caring for medically complex children with neurologic impairment an overview of physiology, symptomatology, and management to differentiate paroxysmal sympathetic hyperactivity from seizures.

Methods: A literature review was conducted using the keywords "autonomic storming," "paroxysmal sympathetic hyperactivity," "seizures," "seizure presentation," and "medically complex children" in Ovid Medline, EBSCOhost, and ClinicalKey online databases. Limits included articles and texts published between 2008-2017 and limited to English. Pediatric and adult literature were included in the review. Nineteen sources were selected for inclusion in the review.

Findings: Diaphoresis, hyperthermia, hypertension, tachycardia, and tachypnea are uniquely associated with paroxysmal sympathetic hyperactivity, whereas unusual ocular and oral movements, cyanosis, salivation, desaturations, and pupillary dilation characterized by a post-ictal period have been more commonly associated with seizures, particularly generalized tonic-clonic seizures of childhood.

Conclusion: Nurses caring for medically complex children may be required to differentiate paroxysmal sympathetic hyperactivity from seizure activity. Accurate assessment, identification, and appropriate intervention are imperative in reducing complications from uncontrolled symptoms. Further research on paroxysmal sympathetic hyperactivity specific to medically complex children and outside of the intensive care unit is indicated.