The hormonal status and the possibility of predicting outcomes in patients with different types of chronic disorders of consciousness

Abstract

BACKGROUND: Chronic disorders of consciousness are rare clinical conditions that develop after coma and are accompanied by the restoration of wakefulness without the full restoration of consciousness 28 days or longer after brain damage. All women with chronic disorders of consciousness have menstrual irregularities such as oligomenorrhea or secondary amenorrhea. Clinical experience shows that recovery of the menstrual response in a number of patients with chronic disorders of consciousness precedes or is combined with recovery of clear consciousness. The results of a comprehensive examination of patients with different types of ovarian failure, depending on the type of chronic disorders of consciousness, have not been presented in the literature. Therefore, an analysis of the results of such an examination can become the basis for the selection of pathogenetically substantiated hormone-modulating therapy and the development of predictive models for assessing recovery of consciousness from chronic disorders of consciousness.

AIM: The aim of this study was to assess the variants of ovarian failure in patients with different types of chronic disorders of consciousness and to develop prognostic models that evaluate the possibility of restoring consciousness.

MATERIALS AND METHODS: This study enrolled 30 patients aged 18 to 44 years divided into three groups depending on the level of consciousness: vegetative state / unresponsive wakefulness syndrome (n = 12), minimally conscious state “minus” (n = 6), and minimally conscious state “plus” (n = 12). Here we examined lipid profile changes (total cholesterol, low-density lipoprotein, high-density lipoprotein) and levels of follicle-stimulating hormone, luteinizing hormone, prolactin, total testosterone, estradiol, free triiodothyronine, thyroxine, thyroid-stimulating hormone, adrenocorticotropic hormone, cortisol, and vitamin 25(OH)D in the blood, as well as levels of melatonin in the blood serum and 6-sulfatoxymelatonin in the urine. In addition, in the blood serum and cerebrospinal fluid, we evaluated levels of brain-derived neurotrophic factor, apoptosis antigen 1, Fas-ligand, glutamate, and S100 protein. We also performed ultrasound of the pelvic organs and mammary glands, magnetic resonance imaging of the chiasmal-sellar region, cervical screening, and genetic study (the prothrombin gene mutation and the Leiden factor).

RESULTS: Hypogonadotropic and normogonadotropic ovarian failures were detected in 36.7% and 63.3% of patients, respectively. No differences in neurotrophin levels between the study groups were found. Three mathematical models were formulated for predicting the recovery of patients into a clear consciousness using the levels of thyroid-stimulating hormone, prolactin, follicle-stimulating hormone, anti-Müllerian hormone, total testosterone, and the age of patients.

CONCLUSIONS: The presented prognostic models by determining hormone levels in the blood plasma allow for calculating the output of patients in clear consciousness. Further research and accumulation of data on patients with chronic disorders of consciousness are promising for the development of new effective approaches to the rehabilitation of this group of patients.

Keywords

chronic disorders of consciousness / minimally conscious state / ovarian failure / melatonin / magnetic resonance imaging of the chiasmatic-sellar region / brain-derived neurotrophic factor / apoptotic antigen 1 / Fas-ligand / glutamate / S100 protein

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