Eugene Lipov
Background: Reactive attachment disorder (RAD) is a psychiatric diagnosis usually made in childhood. It is commonly resistant to treatment, including pharmaceuticals and psychotherapy. A significant clinical feature of RAD is disturbance in affect regulation. This feature of affect regulation abnormality is similar to the over reactivity seen in post traumatic stress disorder (PTSD). A new treatment, called stellate ganglion block (SGB), has been shown to be effective in treating the over reactivity associated with PTSD in the adult population. It involves placing a local anesthetic near a cervical sympathetic ganglion. SGB is believed to reduce sympathetic over activity, which may last for months, leading to improvement in affect regulation. The commonality of abnormal affect regulation (in PTSD and RAD) lead the author to use SGB in a pediatric patient with RAD and in a pediatric patient with PTSD.
Methods: Both patients received a stellate ganglion block on the right side at C6 level utilizing fluoroscopic guidance and 0.5% bupivacaine. Both patients had consent provided for performing the SGB from their parents. The responses to SGB were per parents’, teachers’, and children’s reports.
Results: Both patients experienced immediate, significant and durable relief of RAD and PTSD symptoms, respectively. The PTSD patient requested repeat treatment after three months following added trauma. Both patients markedly reduced antidepressant and antipsychotic medications while maintaining their functional improvements.
Conclusion: Selective blockade of the right stellate ganglion at C6 level is a safe and minimally invasive procedure that may provide durable relief from RAD and PTSD symptoms in a pediatric population, allowing the safe discontinuation of psychiatric medications.
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