Objective To study the clinical characteristics, treatment methods and prognosis of the paroxysmal sympathetic hyperactivity (PSH). Methods We comprehensively analyzed 48 patients diagnosed with PSH from the neurosurgery department of Changzheng Hospital in Shanghai using a prospective study design. The patients were divided into two groups according the treatments they received. In addition to general treatment and hyperbaric oxygen treatment, patients in group A were mainly given propranolol, gabapentin, and benzodiazepines combined therapy, and those in group B received hibernation therapy as controls. The clinical characters, case characteristic, and treatment effect after two weeks of treatment were recorded and compared. Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) scores were used to evaluate the prognoses of patients after 12 months. Results The average age of the PSH patients was (27.48±9.62) years old, with the GCS score ≤ 8 at admission. The treatment group (group A) had a shorter hospitalization time ([206.08±28.57] d vs [223.75±27.74] d, P<0.05) and a shorter episode time after two weeks' treatment ([170.08±79.39] min vs [225.63±105.70] min, P<0.05) compared with the control group. Two patients in group A were lost in the 12 months follow-up. The GOS score of group A was significantly better than that of the control group (P<0.05). The GCS scores were not significantly different between the 40 survived patients in the two groups (20 in each group). Conclusion PSH is commonly seen in young people suffering severe traumatic brain injury, who require early drug treatment. Propranolol combined with gabapentin treatment can improve the prognosis of patients, and it is superior to artificial hibernation by shortening hospitalization time and improving patient survival.