Alpha-2 agonists for refractory neurological symptoms in pediatric palliative care: a scoping review
Abstract
Background: Children receiving palliative care often suffer from refractory neurological symptoms. In recent years, there has been a growing interest in the use of alpha-2 agonists as a second- or third-line therapy for severe dystonia and irritability.
Objectives: The aim of this review was to provide an overview of the scientific literature on the use of alpha-2 agonists for the treatment of refractory neurological symptoms in pediatric palliative care, evaluating the evidence available and identifying gaps related to their reported efficacy and safety.
Methods: A scoping review was performed according to the PRISMA extension. A systematic search was conducted in PubMed, Medline, EMBASE, Web of Science, CINAHL, and The Cochrane Library, using terms referring to alpha-2 agonists and neurological symptoms in pediatric palliative care.
Results: Seven articles were identified, including three case reports, two case series, one observational cohort study, and one retrospective analysis. Two drugs (dexmedetomidine, n = 4/7, and clonidine, n = 3/7) were investigated, encompassing a total of 44 patients aged between 7 months and 18 years. Most patients (95%) initiated treatment in an inpatient setting before transitioning to home care. All patients reported clinical improvement; however, 25% of children treated with clonidine discontinued its use due to ineffectiveness or side effects. No adverse effects were reported with dexmedetomidine use.
Conclusion: Alpha-2 agonists are…
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