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Characteristics of the formation of chronic fatigue syndrome and approaches to its treatment in young patients with focal brain damage.
Boiko, AN, Batysheva, TT, Matvievskaya, OV, Manevich, TM, Gusev, EI
Neuroscience and behavioral physiology. 2007;(3):221-8
Abstract
Chronic fatigue is among the manifestations of focal brain lesions. It is most often encountered in multiple sclerosis (MS) and patients with the sequelae of traumatic, inflammatory, and vascular brain damage (encephalopathies). The aim of the present work was to study the mechanisms of formation of this syndrome in 50 patients with focal brain lesions of different origins (in the inactive stage) and to assess the possibility of correcting it using the combined agent Fezam (2 capsules t.i.d. for one month), which contains piracetam and cinarrizine. In patients with encephalopathies, chronic fatigue syndrome was directly associated with the severity of depression. Patients with MS showed changes in the value-sense sphere. Neuropsychological testing showed that the psychological and personality components played a greater role in the origins of chronic fatigue in patients with encephalopathies than in those with MS. Fezam significantly decreased the severity of chronic fatigue, particularly in patients with MS; in the second group (non-MS patients) this was accompanied by a decrease in the severity of depression. Mild side effects (in six patients--12%) consisted generally of sleep disturbances. These results indicate that Fezam should be used in the treatment of chronic fatigue in patients with focal brain lesions; in encephalopathies it should be combined with psychoactive agents.
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2.
Analysis of the brain bioavailability of peripherally administered magnesium sulfate: A study in humans with acute brain injury undergoing prolonged induced hypermagnesemia.
McKee, JA, Brewer, RP, Macy, GE, Phillips-Bute, B, Campbell, KA, Borel, CO, Reynolds, JD, Warner, DS
Critical care medicine. 2005;(3):661-6
Abstract
OBJECTIVE Based on preclinical investigations, magnesium sulfate (MgSO4) has gained interest as a neuroprotective agent. However, the ability of peripherally administered MgSO4 to penetrate the blood-brain barrier is limited in normal brain. The current study measured the passage of intravenously administered Mg into cerebrospinal fluid in patients with brain injury requiring ventricular drainage. DESIGN A prospective evaluation of the cerebrospinal fluid total and ionized magnesium concentration, [Mg], during sustained hypermagnesemia was performed. SETTING Neurosciences intensive care unit at a major teaching institution. PATIENTS Thirty patients with acute brain injury secondary to subarachnoid hemorrhage, traumatic brain injury, primary intracerebral hemorrhage, subdural hematoma, brain tumor, central nervous system infection, or ischemic stroke were studied. INTERVENTIONS Patients underwent 24 hrs of induced hypermagnesemia during which total and ionized cerebrospinal fluid [Mg] was measured. Serum [Mg] was adjusted to 2.1-2.5 mmol/L. Cerebrospinal fluid [Mg] was measured at baseline, at 12 and 24 hrs after onset of infusion, and at 12 hrs following infusion termination. MEASUREMENTS AND MAIN RESULTS At baseline, total (1.25 +/- 0.14 mmol/L) and ionized (0.80 +/- 0.10 mmol/L) cerebrospinal fluid [Mg] was greater than serum total (0.92 +/- 0.18 mmol/L) and ionized (0.63 +/- 0.07 mmol/L) [Mg] (p < .05). Total (1.43 +/- 0.13 mmol/L) and ionized (0.89 +/- 0.12 mmol/L) cerebrospinal fluid [Mg] was maximally increased by 15% and 11% relative to baseline, respectively, during induced hypermagnesemia (p < .05). CONCLUSIONS Hypermagnesemia produced only marginal increases in total and ionized cerebrospinal fluid [Mg]. Regulation of cerebrospinal fluid [Mg] is largely maintained following acute brain injury and limits the brain bioavailability of MgSO4.
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3.
[Effect of compound Salvia injection on blood coagulation in patients with traumatic cerebral infarction].
Zhang, RJ, You, C, Cai, BW, Wan, Y, He, M, Li, H
Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine. 2004;(10):882-4
Abstract
OBJECTIVE To investigate the effect of compound Salvia injection (CSI) on blood coagulatory function in patients with traumatic cerebral infarction (TCI). METHODS Sixty-four patients with TCI were randomly divided into two groups, 32 in each group. The treated group were treated with CSI plus conventional treatment of western medicine, and the control group treated with conventional treatment alone. Changes of symptoms, levels of plasma P-selectin (P-S), von Willebrand's factor (vWf) and D-dimer were observed with ELISA. RESULTS The treated group was superior to the control group in Glasgow outcome scale (P < 0.01). Before treatment, the levels of plasma P-S, vWf and D-dimer in the TCI patients were higher than those in healthy people. After treatment, all the parameters lowered in both groups, but the effect of lowering was greater in the treated group than that in the control group. CONCLUSION Blood coagulation disorder exists in patients with TCI, CSI could improve it, and might alleviate the cerebral damage to a certain extent.
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4.
Effect of methylphenidate on vital signs and adverse effects in adults with traumatic brain injury.
Alban, JP, Hopson, MM, Ly, V, Whyte, J
American journal of physical medicine & rehabilitation. 2004;(2):131-7; quiz 138-41, 167
Abstract
OBJECTIVE To study methylphenidate's adverse effects and impact on vital signs within the adult traumatic brain injury population. DESIGN Thirty-five adults with traumatic brain injury enrolled in a double-blind, placebo-controlled, 6-wk crossover study of methylphenidate, given in a dose of 0.3 mg/kg/dose, twice a day. Vital signs were taken by trained clinicians and research assistants. Participants filled out weekly questionnaires pertaining to the adverse effects. RESULTS Poor appetite was the only adverse effect related to methylphenidate. Other adverse effects commonly associated with methylphenidate, such as insomnia, rapid heart rate, and anxiety, were not found to be significantly related to the medication. The average rise in mean arterial pressure on methylphenidate was 2.5 mm. Methylphenidate showed a stronger impact on pulse, with an average increase of 7 beats/min. Baseline vital signs did not predict the degree of increase on methylphenidate. CONCLUSION Methylphenidate appears to be safe for the adult population with traumatic brain injury. However, because a few individuals experienced significant changes in vital signs and adverse effects, all patients should be monitored.
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5.
Efficacy of moderate hypothermia in patients with severe head injury and intracranial hypertension refractory to mild hypothermia.
Shiozaki, T, Nakajima, Y, Taneda, M, Tasaki, O, Inoue, Y, Ikegawa, H, Matsushima, A, Tanaka, H, Shimazu, T, Sugimoto, H
Journal of neurosurgery. 2003;(1):47-51
Abstract
OBJECT This study was performed to determine whether moderate hypothermia (31 degrees C) improves clinical outcome in severely head injured patients whose intracranial hypertension cannot be controlled using mild hypothermia (34 degrees C). METHODS Twenty-two consecutive severely head injured patients who fulfilled the following criteria were included in this study: an intracranial pressure (ICP) that remained higher than 40 mm Hg despite the use of mild hypothermia combined with conventional therapies; and a Glasgow Coma Scale score of 8 or less on admission. After the failure of mild hypothermia in combination with conventional therapies; patients were exposed to moderate hypothermia as quickly as possible. As brain temperature was reduced from 34 to 31 degrees C, the volume of intravenous fluid infusion was increased significantly from 1.9 +/- 0.9 to 2.6 +/- 1.2 mg/kg/hr (p < 0.01), and the dose of dopamine infusion increased significantly from 4.3 +/- 3.1 to 8.2 +/- 4.4 microg/kg/min (p < 0.01). Nevertheless, mean arterial blood pressure and heart rate decreased significantly from 97.1 +/- 13.1 to 85.1 +/- 10.5 mm Hg (p < 0.01) and from 92.2 +/- 13.8 to 72.2 +/- 14.3 beats/minute at (p < 0.01) at 34 and 31 degrees C, respectively. Arterial base excess was significantly aggravated from -3.3 +/- 4 at 34 degrees C to -5.6 +/- 5.4 mEq/L (at 31 degrees C; p < 0.05). Likewise, serum potassium concentration, white blood cell counts, and platelet counts at 31 degrees C decreased significantly compared with those at 34 degrees C (p < 0.01). In 19 (86%) of 22 patients, elevation of ICP could not be prevented using moderate hypothermia. In the remaining three patients. ICP was maintained below 40 mm Hg by inducing moderate hypothermia; however, these three patients died of multiple organ failure. These results clearly indicate that moderate hypothermia induces complications more severe than those induced by mild hypothermia without improving outcomes. CONCLUSIONS The authors concluded that moderate hypothermia is not effective in improving clinical outcomes in severely head injured patients whose ICP remains higher than 40 mm Hg after treatment with mild hypothermia combined with conventional therapies.
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6.
Clinical cerebral microdialysis: brain metabolism and brain tissue oxygenation after acute brain injury.
Meixensberger, J, Kunze, E, Barcsay, E, Vaeth, A, Roosen, K
Neurological research. 2001;(8):801-6
Abstract
While continuous monitoring of brain tissue oxygenation (P(ti)O2) is known as a practicable, safe and reliable monitoring technology supplementing traditional ICP-CPP-monitoring, the impact of cerebral microdialysis, now available bedside, is not proven extensively. Therefore our studies focused on the practicability, complications and clinical impact of microdialysis during long term monitoring after acute brain injury, especially the analysis of the correlation between changes of local brain oxygenation and metabolism. Advanced neuromonitoring including ICP-CPP-p(ti)O2 was performed in 20 patients suffering from acute brain injury. Analysis of the extracellular fluid metabolites (glucose, lactate, pyruvate, glutamate) were performed bedside hourly. No catheter associated complications, like infection and bleeding, occurred. However, longterm monitoring was limited in 5 out of 20 patients caused by obliteration of the microdialysis catheter after 3-4 days. In the individual patients partly a correlation between increased lactate levels as well as lactate pyruvate ratios and hypoxic brain tissue oxygenation could be found. Analysing the data sets of all patients only a low correlation was detected indicating physiological and increased lactate and lactate/pyruvate ratio during sufficient brain oxygenation. Additionally, concentrations of excitatory amino acid glutamate were found in normal and elevated range during periods of hypoxic oxygenation (P(ti)O2 < 10 mmHg) and intracranial hypertension. Our data strongly suggest partly evidence of correlation between hypoxic oxygenation and metabolic disturbances after brain injury. On the other hand brain metabolism is altered without changes of cerebral oxygenation. Further studies are indicated to improve our pathophysiological knowledge before microdialysis is routinely useful in neurointensive care.
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7.
The early fall in levels of S-100 beta in traumatic brain injury.
Jackson, RG, Samra, GS, Radcliffe, J, Clark, GH, Price, CP
Clinical chemistry and laboratory medicine. 2000;(11):1165-7
Abstract
Protein S-100 beta has been suggested as a prognostic marker in traumatic brain injury. However, little is known of its behaviour in the immediate post-injury period. With Ethics Committee approval, we recruited 30 patients with a history of head injury presenting to our Accident and Emergency Department. Blood was taken on arrival and at four hours post-injury. Serum S-100 beta was estimated using an immunoluminometric assay. Levels of S-100 beta were seen to fall rapidly with time. Half-time was distributed non-parametrically with a median of 198 minutes. Using the Mann-Whitney U test we found a statistically significant difference between non-desirable (Glasgow Outcome Score 1-3) and desirable (Glasgow Outcome Score 4-5) outcome on admission (p = 0.0155) but not at four hours (p = 0.1336). Levels of S-100 beta fell rapidly after its release following traumatic brain injury. Time after injury is therefore critical in assessing the significance of levels of S-100 beta, and sampling should be as early as possible to gain maximum information. If S-100 beta is to be assessed as a monitor of ongoing brain injury in the intensive therapy unit sampling must be frequent (e.g. every 4 hours) to be able to detect rises in serum levels before they have decayed to baseline.