Healthier rhythm, healthier brain? Integrity of circadian melatonin and temperature rhythms relates to the clinical state of brain-injured patients.

BACKGROUND: Healthy circadian rhythmicity has been suggested to relate to a better state of brain-injured patients and to support the emergence of consciousness in patient groups characterized by a relative instability thereof such as patients with disorders of consciousness (DOC). METHODS: Going beyond earlier studies, a systems-level perspective was adopted and, using multilevel modelling, the joint predictive value of three indices of circadian rhythm integrity derived from skin temperature variations, melatoninsulfate secretion, and physical activity (wrist actigraphy) patterns was evaluated for the behaviourally assessed state [Coma Recovery Scale - Revised (CRS-R) score] of DOC patients [13 unresponsive wakefulness syndrome; seven minimally conscious (exit) state]. Additionally, it was assessed in a subset of 16 patients whether patients' behavioural repertoire (CRS-R score) varied (i) with time of day or (ii) offset from the body temperature maximum (BTmax ), i.e. when cognitive performance is expected to peak. RESULTS: The results reveal that better integrity of circadian melatoninsulfate and temperature rhythms relate to a richer behavioural repertoire. Moreover, higher CRS-R scores are, by trend, related to assessments taking place at a later daytime or deviating less from the pre-specified time of occurrence of BTmax . CONCLUSIONS: In conclusion, the results suggest that therapeutic approaches aimed at improving circadian rhythms in brain-injured patients are promising and should be implemented in hospitals or nursing homes. Beyond this, it might be helpful to schedule diagnostic procedures and therapies around the (pre-assessed) BTmax (≈4 pm in healthy individuals) as this is when patients should be most responsive.

[Treatment of reactive stuporous states with L-DOPA]. / Lechenie reaktivnykh stuporoznykh sostoianii preparatom L-DOFA.

The paper presents the results of L-dopa use for the treatment of patients with reactive stuporous states. The assumption concerning curability of these patients is based on the similarity of a number of their clinical and biochemical manifestations with an akynetic-rigid form of parkinsonism where L-dopa is very effective. From 25 patients with reactive psychoses 7 demonstrated recovery, 3 patients--significant improvement, 5 patients--improvement and 10 patients--absence of the effect. The drug is the most effective in the stuporous depth of psychomotor inhibition in persons with a monomorphic structure of stuporous syndromes, rather "frequent" depressive disorders and a decrease of a background level of dopamine excreation with urine. Use of L-dopa in schizophrenic stuporous states (5 patients) was ineffective.