Is circadian rhythmicity a prerequisite to coma recovery? Circadian recovery concomitant to cognitive improvement in two comatose patients. Issue 3 (6th February 2019)

• Record Type: Journal Article
• Authors: Gobert, Florent; Luauté, Jacques; Raverot, Véronique; Cotton, François; Dailler, Frédéric; Claustrat, Bruno; Perrin, Fabien; Gronfier, Claude
• Is Part Of: Journal of pineal research. Volume 66:Issue 3(2019)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-02-06
• Subjects: biomarkers -- circadian rhythm -- cognition -- coma -- hypothalamus -- melatonin -- traumatic brain injury; Pineal gland -- Periodicals; Pineal Gland -- Periodicals; Épiphyse (Glande); Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 612.492
• DOI: 10.1111/jpi.12555
• Languages: English
• ISSNs: 0742-3098

Abstract

Abstract: Circadian rhythmicity (CR) is involved in the regulation of all integrated functions, from sleep‐wake cycle regulation to metabolic function, mood and cognition. However, the interdependence of CR, cognition and consciousness has been poorly addressed. To clarify the state of CR in coma and to determine the chronological relationship between its recovery and consciousness after brain lesions, we conducted a longitudinal observational study investigating how the state of CR was chronologically related with the recovery of behavioural wakefulness, cognition and/or awareness. Among 16 acute comatose patients, we recruited two 37‐year‐old patients with a persistent disorder of consciousness, presenting diencephalic lesions caused by severe traumatic brain injuries. Two biological urinary markers of CR were explored every 2 hours during 24 hours (6‐sulfatoxymelatonin, free cortisol) with a dedicated methodology to extract the endogenous component of rhythmicity (environmental light recording, near‐constant‐routine protocol, control of beta‐blockers). They presented an initial absence of rhythmic secretions and a recovered CR 7‐8 months later. This recovery was not associated with the restoration of behavioural wakefulness, but with an improvement of cognition and awareness (up to the minimally conscious state). MRI showed a lesion pattern compatible with the interruption of either the main hypothalamic‐sympathetic pathway or the accessory habenular pathway. These results suggest that CR may be a prerequisite for coma recovery with a potential but still unproven favourable effect on brain function of the resorted circadian melatonin secretion and/or the functional recovery of the suprachiasmatic nucleus (SCN). Assessing circadian functions by urinary melatonin should be further explored as a biomarker of cognition reappearance and investigated to prognosticate functional recovery.