Efficacy of cervical sympathetic blockade in the treatment of primary and secondary PTSD symptoms: A case series

BACKGROUND: Post-traumatic stress disorder (PTSD) can develop in individuals following exposure to an overwhelmingly traumatic event. Secondary PTSD is defined as occurring after exposure to a person with primary PTSD, such as an intimate partner. Successful treatment of PTSD symptoms by the use of cervical sympathetic blockade (CSB) has been previously reported to help with symptoms irrespective of PTSD cause. OBJECTIVE: To describe the efficacy of CSB in treating symptoms of primary and secondary PTSD in two couples, and visualize CSB impact through neuroimaging. METHODS: Four patients received CSB at C6 and C4 with ultrasound guidance on the right side followed by the left side a day later. PTSD symptoms were evaluated in all patients using the PTSD Checklist (PCL-5) before and after the procedure. Patients underwent SPECT scans acquired using a high resolution Picker (Philips) Prism XP 3000 triple-headed gamma camera, with low-energy high-resolution fan beam collimators, one day before and one week after the procedures. RESULTS: CSB showed acute benefit for symptoms of primary and secondary PTSD, offering a clinically significant reduction in PTSD symptoms in all four patients. The PCL-5 scores of patients with primary PTSD were reduced from 41 to 7 and from 44 to 6 on the 80-point scale. The PCL-5 scores of patients with secondary PTSD were reduced from 40 to 17 and from 43 to 7 on the 80-point scale. Furthermore, SPECT imaging showed stark increases in activity in the prefrontal pole and thalamus in all patients, and increases in activity in the inferior orbital prefrontal cortex in three of four cases. Modulation of activity in the temporal lobes, orbital prefrontal cortex and basal ganglia was also noted after the procedure. CONCLUSION: CSB is a minimally invasive procedure with an excellent safety profile, providing relief of primary and secondary PTSD symptoms. The increase in prefrontal pole, thalamus and inferior orbital activity correlates with the improved symptomatology.