Plasma norepinephrine and dopamine level changes during recovery of consciousness in patients with damaged deep brain structures due to severe TBI

Alexandrova, E.; Tenedieva, V.; Zaitsev, O.; Potapov, A.; Voronov, V.; Vorobyov, Y.

Авторы: Eugenia Alexandrova, Valeria Tenedieva, Oleg Zaitsev, Alexander Potapov, Vladimir Voronov, Yuriy Vorobyov
Журнал: Journal of Neurotrauma
Том: 24
Номер: 7
Год издания: 2007
Издательство: Mary Ann Liebert Inc.
Местоположение издательства: United States
Первая страница: 1264
Последняя страница: 1264
DOI: 10.1089/neu.2007.9972
Аннотация: Posttraumatic unconsciousness is a clinical manifestation of disconnection between the brainstem (noradrenergic fibers), subcortical structures (dopaminergic system) and cortex, particularly frontal lobes (FL), which are involved in modulation of the sympathetic nervous system, the main source of plasma norepinephrine (NE) and dopamine (DA).OBJECTIVE: To compare the NE and DA (catecholamines - CA) level changes in patients with traumatic brain injury (TBI) involving the deep structures and bilateral FL (Group A) and without bilateral FL damage (Group B). METODS: 21 patients were enrolled in this study: 14 in group A and 7 in group B. The extent of brain damage was verified by MRI/CT in all patients. The duration of follow up was 440 days. Consciousness levels were staged using the following criteria: eye opening only tracking (stage 1), obeying commands attempts to speak (stage 2), answers questions orientation (stage 3). Plasma CA and NSE (as injury’s marker) levels were evaluated by HPLC and RIA respectively. RESULTS: NE and DA levels dissociation in group A was significantly higher than in group B on stage 2 (2 5,6;p 0,025) and stage 3 (2 4,19;p 0,05). A negative correlation trend of NA and DA levels was demonstrated in both groups on stage 1 (rs0,2), at stage 2 in group A (rs0,16) and a trend to positive correlation in group B at stages 2 (rs 0,38) and 3 (rs 0,28). In patients in stage 3 group A patients showed significant positive correlation (rs 0,7, p 0.05), except 5 patients in psychomotor agitation, who demonstrated negative correlation (rs0,68, p 0.05). DISCUSSION: Unconscious states are characterized by dissociation of NA and DA levels. Emergence of cortical activity in patients with bilateral FL damage is associated with persistent CA dissociation, which may be particularly prominent in patients with excitement. The CA dissociation disappears in patients without FL damage. We propose that plasma NA and DA level changes can be used as surrogate markers of recovery (or lack thereof) of the level of consciousness in patients with severe TBI. They may also reflect biochemical changes associated with function recovery of the FL.
Добавил в систему: Зайцев Олег Семенович

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