REVIEW article
Front. Pediatr.
Sec. General Pediatrics and Pediatric Emergency Care
Volume 13 - 2025 | doi: 10.3389/fped.2025.1542482
This article is part of the Research TopicNovel targets in pediatrics: advances in diagnostic and therapeutic approachesView all 6 articles
Alpha-2 agonists for refractory neurological symptoms in Pediatric Palliative Care: a scoping review
Provisionally accepted
- 1Palliative Care and Pain Service, Department of Women's and Children's Health - University of Padova, Padova, Italy
- 2Department of Women’s and Children’s Health, University Hospital of Padova, Padova, Italy
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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: A total of 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 increasingly being used to manage intractable neurological symptoms in pediatric palliative care. However, evidence regarding their safety profile and effectiveness remains limited, highlighting the need for further research in this area.
Keywords: Alpha-2 agonist agents, refractory neurological symptoms, irritability, Dystonia, Pediatric palliative care, Clonidine, Dexmedetomidine
Received: 09 Dec 2024; Accepted: 16 Apr 2025.
Copyright: © 2025 Salerno, Baratiri, Piana, Bincoletto, Benini and Zanin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Annalisa Salerno, Palliative Care and Pain Service, Department of Women's and Children's Health - University of Padova, Padova, Italy
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.