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Carlos RM, Matias CN, Cavaca ML, Cardoso S, Santos DA, Giro R, Vaz JR, Pereira P, Vicente F, Leonardo-Mendonça RC, Ganhão-Arranhado S, Santos HO, Reiter RJ, Teixeira FJ. The effects of melatonin and magnesium in a novel supplement delivery system on sleep scores, body composition and metabolism in otherwise healthy individuals with sleep disturbances. Chronobiol Int 2024; 41:817-828. [PMID: 38745424 DOI: 10.1080/07420528.2024.2353225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 05/01/2024] [Indexed: 05/16/2024]
Abstract
The purpose of this study was to investigate the effects of a novel dietary supplement, including melatonin and magnesium, delivered via coffee pods on sleep quality, resting metabolic rate (RMR), and body composition in individuals with poor sleep quality disturbances. Using a double-blinded, randomized, crossover trial, we recruited 35 participants to a 4-week intervention with both supplements (1.9 mg melatonin + 200 mg elemental magnesium before sleep) and placebo conditions, considering a 7d washout period between treatments. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was applied, RMR (kcal) was measured using indirect calorimetry (canopy ventilated open-circuit system) and body composition was assessed using dual-energy X-ray absorptiometry. Decreases in PSQI and anger - hostility scores, as well as in energy intake and fat mass, were observed (p < 0.05) for both conditions, from baseline to the end of each 4-week intervention. Differences between conditions were also observed for these parameters along with energy spent in activity, number of sedentary breaks, sleep efficiency, latency time, time in bed, total sleep time, awakening time, and movement index (p < 0.05) favouring the supplement condition. However, the final PSQI questionnaire scores still indicated poor sleep quality on average (PSQI > 5), in both conditions, with no changes regarding RMR. A melatonin-magnesium supplement, in a coffee pod format, showed improvements in sleep quality in otherwise healthy individuals with sleep disturbances, however PSQI questionnaire scores still indicated poor quality on average (PSQI > 5).
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Affiliation(s)
- Rafael M Carlos
- Atlântica - Instituto Universitário, Fábrica da Pólvora de Barcarena, 2730-036 Barcarena, Portugal
- Bettery Lifelab, Bettery S.A., Lisboa, Portugal
| | - Catarina N Matias
- Bettery Lifelab, Bettery S.A., Lisboa, Portugal
- CIDEFES, Universidade Lusófona, Lisboa, Portugal
| | - Margarida L Cavaca
- Bettery Lifelab, Bettery S.A., Lisboa, Portugal
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Portugal
| | - Sofia Cardoso
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Portugal
| | - Diana A Santos
- ESECS, Polytechnic University of Leiria, Leiria, Portugal
- Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD), Portugal
| | - Rita Giro
- Bettery Lifelab, Bettery S.A., Lisboa, Portugal
| | - João R Vaz
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Portugal
- Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Monte de Caparica, Portugal
| | - Paula Pereira
- Grupo de Estudos em Nutrição Aplicada (GENA), CiiEM, Egas Moniz-Cooperativa de Ensino Superior, Almada, Portugal
| | - Filipa Vicente
- Grupo de Estudos em Nutrição Aplicada (GENA), CiiEM, Egas Moniz-Cooperativa de Ensino Superior, Almada, Portugal
| | | | - Susana Ganhão-Arranhado
- Atlântica - Instituto Universitário, Fábrica da Pólvora de Barcarena, 2730-036 Barcarena, Portugal
- CINTESIS, Center for Health Technology and Services Research, Porto, Portugal
| | - Heitor O Santos
- School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Brazil
| | - Russel J Reiter
- Department of Cell Systems and Anatomy, UT Health Long School of Medicine, San Antonio, Texas, USA
| | - Filipe J Teixeira
- Atlântica - Instituto Universitário, Fábrica da Pólvora de Barcarena, 2730-036 Barcarena, Portugal
- Bettery Lifelab, Bettery S.A., Lisboa, Portugal
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Portugal
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Kulsoom K, Ali W, Saba Z, Hussain S, Zahra S, Irshad M, Ramzan MS. Revealing Melatonin's Mysteries: Receptors, Signaling Pathways, and Therapeutics Applications. Horm Metab Res 2024; 56:405-418. [PMID: 38081221 DOI: 10.1055/a-2226-3971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Melatonin (5-methoxy-acetyl tryptamine) is a sleep-inducing hormone, and the pineal gland produces it in response to the circadian clock of darkness. In the body, MT1 and MT2 receptors are mostly found, having an orthosteric pocket and ligand binding determinants. Melatonin acts by binding on melatonin receptors, intracellular proteins, and orphan nuclear receptors. It inhibits adenyl cyclase and activates phospholipase C, resulting in gene expression and an intracellular alteration environment. Melatonin signaling pathways are also associated with other intracellular signaling pathways, i. e., cAMP/PKA and MAPK/ERK pathways. Relative expression of different proteins depends on the coupling profile of G protein, accounting pharmacology of the melatonin receptor bias system, and mediates action in a Gi-dependent manner. It shows antioxidant, antitumor, antiproliferative, and neuroprotective activity. Different types of melatonin agonists have been synthesized for the treatment of sleeping disorders. Researchers have developed therapeutics that target melatonin signaling, which could benefit a wide range of medical conditions. This review focuses on melatonin receptors, pharmacology, and signaling cascades; it aims to provide basic mechanical aspects of the receptor's pharmacology, melatonin's functions in cancer and neurodegenerative diseases, and any treatments and drugs designed for these diseases. This will allow a basic comparison between the receptors in question, highlighting any parallels and differences that may exist and providing fundamental knowledge about these receptors to future researchers.
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Affiliation(s)
- Kulsoom Kulsoom
- Department of Biochemistry, Bahauddin Zakariya University, Multan, Pakistan
| | - Wajahat Ali
- School of Basic Medical Sciences, Xi'an Jiaotong University, Xian, China
| | - Zainab Saba
- Department of Optometry, Khwaja Fareed University of Engineering & Information Technology, Rahim Yar Khan, Pakistan
| | - Shabab Hussain
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, Universita degli studi di Messina, Messina, Italy
| | - Samra Zahra
- Department of Biosciences, COMSATS University Islamabad, Pakistan
| | - Maria Irshad
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Muhammad Saeed Ramzan
- Department of Pharmacology, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
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Fedele B, Williams G, McKenzie D, Giles R, McKay A, Olver J. Sleep Disturbance During Post-Traumatic Amnesia and Early Recovery After Traumatic Brain Injury. J Neurotrauma 2024. [PMID: 38553904 DOI: 10.1089/neu.2023.0656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
After moderate to severe traumatic brain injury (TBI), sleep disturbance commonly emerges during the confused post-traumatic amnesia (PTA) recovery stage. However, the evaluation of early sleep disturbance during PTA, its recovery trajectory, and influencing factors is limited. This study aimed to evaluate sleep outcomes in patients experiencing PTA using ambulatory gold-standard polysomnography (PSG) overnight and salivary endogenous melatonin (a hormone that influences the sleep-wake cycle) assessment at two time-points. The relationships between PSG-derived sleep-wake parameters and PTA symptoms (i.e., agitation and cognitive disturbance) were also evaluated. In a patient subset, PSG was repeated after PTA had resolved to assess the trajectory of sleep disturbance. Participants with PTA were recruited from Epworth HealthCare's inpatient TBI Rehabilitation Unit. Trained nurses administered overnight PSG at the patient bedside using the Compumedics Somté portable PSG device (Compumedics, Ltd., Australia). Two weeks after PTA had resolved, PSG was repeated. On a separate evening, two saliva specimens were collected (at 24:00 and 06:00) for melatonin testing. Results of routine daily hospital measures (i.e., Agitated Behavior Scale and Westmead PTA Scale) were also collected. Twenty-nine patients were monitored with PSG (mean: 41.6 days post-TBI; standard deviation [SD]: 28.3). Patients' mean sleep duration was reduced (5.6 h, SD: 1.2), and was fragmented with frequent awakenings (mean: 27.7, SD: 15.0). Deep, slow-wave restorative sleep was reduced, or completely absent (37.9% of patients). The use of PSG did not appear to exacerbate patient agitation or cognitive disturbance. Mean melatonin levels at both time-points were commonly outside of normal reference ranges. After PTA resolved, patients (n = 11) displayed significantly longer mean sleep time (5.3 h [PTA]; 6.5 h [out of PTA], difference between means: 1.2, p = 0.005). However, disturbances to other sleep-wake parameters (e.g., increased awakenings, wake time, and sleep latency) persisted after PTA resolved. This is the first study to evaluate sleep disturbance in a cohort of patients as they progressed through the early TBI recovery phases. There is a clear need for tailored assessment of sleep disturbance during PTA, which currently does not form part of routine hospital assessment, to suggest new treatment paradigms, enhance patient recovery, and reduce its long-term impacts.
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Affiliation(s)
- Bianca Fedele
- Department of Rehabilitation, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Rehabilitation, Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Gavin Williams
- Department of Rehabilitation, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Rehabilitation, Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Dean McKenzie
- Research Development and Governance Unit, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robert Giles
- Sleep Unit, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
| | - Adam McKay
- Department of Rehabilitation, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - John Olver
- Department of Rehabilitation, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Rehabilitation, Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
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Del Casale A, Arena JF, Giannetti F, Minervino A, Biggio G, Girardi P. The use of prolonged-release melatonin in circadian medicine: a systematic review. Minerva Med 2024; 115:125-142. [PMID: 38713204 DOI: 10.23736/s0026-4806.24.09303-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Melatonin, a hormone produced by the pineal gland, regulates the sleep-wake cycle and is effective in restoring biological rhythms. Prolonged-release melatonin (PRM) is designed to mimic the natural physiological pattern of melatonin release. In circadian medicine, PRM can be used to treat sleep and circadian rhythm disorders, as well as numerous organic diseases associated with sleep disorders. EVIDENCE ACQUISITION This systematic review analyzed 62 studies and adhered to the PRISMA guidelines, examining the effectiveness of PRM in organic pathologies and mental disorders. EVIDENCE SYNTHESIS The main evidence concerns primary insomnia in subjects over the age of 55, showing significant improvements in sleep quality. In neurodevelopmental disorders, there is evidence of a positive impact on sleep quality and quality of life for patients and their caregivers. PRM shows efficacy in the treatment of sleep disorders in mood disorders, schizophrenia, and neurocognitive disorders, but requires further confirmation. The additional use of PRM is supported for the withdrawal of chronic benzodiazepine therapies. The tolerability and safety of PRM are excellent, with ample evidence supporting the absence of tolerance and dependence. CONCLUSIONS Overall, PRM in circadian medicine is an effective chronopharmaceutical for restoring the sleep-wake rhythm in patients with insomnia disorder. This efficacy may also extend to sleep disorders associated with mood, neurodevelopmental and neurocognitive disorders, suggesting a further potential role in insomnia associated with various organic diseases.
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Affiliation(s)
- Antonio Del Casale
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy -
- Emergency and Admissions Department, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy -
| | - Jan F Arena
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | | | | | - Giovanni Biggio
- Department of Life and Environmental Sciences, Institute of Neurosciences, University of Cagliari, Cagliari, Italy
| | - Paolo Girardi
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
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Thorne J, Hellewell SC, Cowen G, Ring A, Jefferson A, Chih H, Gozt AK, Buhagiar F, Thomas E, Papini M, Bynevelt M, Celenza A, Xu D, Honeybul S, Pestell CF, Fatovich D, Fitzgerald M. Symptoms Associated With Exercise Intolerance and Resting Heart Rate Following Mild Traumatic Brain Injury. J Head Trauma Rehabil 2024:00001199-990000000-00129. [PMID: 38453632 DOI: 10.1097/htr.0000000000000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVES People may experience a myriad of symptoms after mild traumatic brain injury (mTBI), but the relationship between symptoms and objective assessments is poorly characterized. This study sought to investigate the association between symptoms, resting heart rate (HR), and exercise tolerance in individuals following mTBI, with a secondary aim to examine the relationship between symptom-based clinical profiles and recovery. METHODS Prospective observational study of adults aged 18 to 65 years who had sustained mTBI within the previous 7 days. Symptoms were assessed using the Post-Concussion Symptom Scale, HR was measured at rest, and exercise tolerance was assessed using the Buffalo Concussion Bike Test. Symptom burden and symptom-based clinical profiles were examined with respect to exercise tolerance and resting HR. RESULTS Data from 32 participants were assessed (mean age 36.5 ± 12.6 years, 41% female, 5.7 ± 1.1 days since injury). Symptom burden (number of symptoms and symptom severity) was significantly associated with exercise intolerance (P = .002 and P = .025, respectively). Physiological and vestibular-ocular clinical profile composite groups were associated with exercise tolerance (P = .001 and P = .014, respectively), with individuals who were exercise intolerant having a higher mean number of symptoms in each profile than those who were exercise tolerant. Mood-related and autonomic clinical profiles were associated with a higher resting HR (>80 bpm) (P = .048 and P = .028, respectively), suggesting altered autonomic response for participants with symptoms relating to this profile. After adjusting for age and mechanism of injury (sports- or non-sports-related), having a higher mood-related clinical profile was associated with persisting symptoms at 3 months postinjury (adjusted odds ratio = 2.08; 95% CI, 1.11-3.90; P = .013). CONCLUSION Symptom-based clinical profiles, in conjunction with objective measures such as resting HR and exercise tolerance, are important components of clinical care for those having sustained mTBI. These results provide preliminary support for the concept that specific symptoms are indicative of autonomic dysfunction following mTBI.
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Affiliation(s)
- Jacinta Thorne
- Author Affiliations: School of Allied Health (Ms Thorne and Mr Ring) and Curtin Medical School (Drs Cowen, Jefferson, and Xu), Faculty of Health Sciences, Curtin Health Innovation Research Institute (Mss Thorne and Papini and Drs Hellewell, Cowen, Gozt, Pestell, and Fitzgerald), and School of Population Health (Drs Chih, Thomas, and Xu), Curtin University, Bentley, Western Australia; Perron Institute for Neurological and Translational Science, Nedlands, Western Australia (Mss Thorne and Papini and Drs Hellewell, Gozt, and Fitzgerald); Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia (Mr Ring); School of Psychological Science (Drs Buhagiar and Pestell) and Divisions of Surgery (Dr Thomas) and Emergency Medicine (Dr Celenza), School of Medicine, The University of Western Australia, Nedlands, Western Australia; Neurological Intervention & Imaging Service of Western Australia (Dr Bynevelt) and Emergency Department (Dr Celenza), Sir Charles Gairdner Hospital, Nedlands, Western Australia; The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Dr Xu); Sir Charles Gairdner, Royal Perth and Fiona Stanley Hospitals, Perth, Western Australia (Dr Honeybul); Emergency Medicine, Royal Perth Hospital, University of Western Australia (Dr Fatovich); and Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Nedlands, Western Australia (Dr Fatovich)
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Li W, Chen R, Feng L, Dang X, Liu J, Chen T, Yang J, Su X, Lv L, Li T, Zhang Z, Luo XJ. Genome-wide meta-analysis, functional genomics and integrative analyses implicate new risk genes and therapeutic targets for anxiety disorders. Nat Hum Behav 2024; 8:361-379. [PMID: 37945807 DOI: 10.1038/s41562-023-01746-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 10/04/2023] [Indexed: 11/12/2023]
Abstract
Anxiety disorders are the most prevalent mental disorders. However, the genetic etiology of anxiety disorders remains largely unknown. Here we conducted a genome-wide meta-analysis on anxiety disorders by including 74,973 (28,392 proxy) cases and 400,243 (146,771 proxy) controls. We identified 14 risk loci, including 10 new associations near CNTNAP5, MAP2, RAB9BP1, BTN1A1, PRR16, PCLO, PTPRD, FARP1, CDH2 and RAB27B. Functional genomics and fine-mapping pinpointed the potential causal variants, and expression quantitative trait loci analysis revealed the potential target genes regulated by the risk variants. Integrative analyses, including transcriptome-wide association study, proteome-wide association study and colocalization analyses, prioritized potential causal genes (including CTNND1 and RAB27B). Evidence from multiple analyses revealed possibly causal genes, including RAB27B, BTN3A2, PCLO and CTNND1. Finally, we showed that Ctnnd1 knockdown affected dendritic spine density and resulted in anxiety-like behaviours in mice, revealing the potential role of CTNND1 in anxiety disorders. Our study identified new risk loci, potential causal variants and genes for anxiety disorders, providing insights into the genetic architecture of anxiety disorders and potential therapeutic targets.
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Affiliation(s)
- Wenqiang Li
- Henan Mental Hospital, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Rui Chen
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
| | - Laipeng Feng
- Henan Mental Hospital, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xinglun Dang
- Department of Psychosomatics and Psychiatry, Zhongda Hospital, School of Medicine, Advanced Institute for Life and Health, Southeast University, Nanjing, China
| | - Jiewei Liu
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
| | - Tengfei Chen
- Henan Mental Hospital, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Jinfeng Yang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
| | - Xi Su
- Henan Mental Hospital, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Luxian Lv
- Henan Mental Hospital, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Tao Li
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhijun Zhang
- Department of Psychosomatics and Psychiatry, Zhongda Hospital, School of Medicine, Advanced Institute for Life and Health, Southeast University, Nanjing, China
- Department of Neurology, Affiliated Zhongda Hospital, Southeast University, Nanjing, China
- Department of Mental Health and Public Health, Faculty of Life and Health Sciences, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xiong-Jian Luo
- Department of Psychosomatics and Psychiatry, Zhongda Hospital, School of Medicine, Advanced Institute for Life and Health, Southeast University, Nanjing, China.
- Department of Neurology, Affiliated Zhongda Hospital, Southeast University, Nanjing, China.
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De Simone M, De Feo R, Choucha A, Ciaglia E, Fezeu F. Enhancing Sleep Quality: Assessing the Efficacy of a Fixed Combination of Linden, Hawthorn, Vitamin B1, and Melatonin. Med Sci (Basel) 2023; 12:2. [PMID: 38249078 PMCID: PMC10801487 DOI: 10.3390/medsci12010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/24/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Sleep is essential for overall health, yet various sleep disorders disrupt normal sleep patterns, affecting duration, quality, and timing. This pilot study investigate the impact of a food supplement (SPINOFF®) on both sleep quality and mental well-being in 41 participants (mean age: 45.3 years). Initial assessments revealed sleep disturbances (Pittsburgh Sleep Quality Index-PSQ-mean score: 8.2) and insomnia symptoms (Insomnia Severity Index-ISI- mean score: 12.7). Mental health assessments showed psychological distress (Dass-21 Depression mean score: 4.2, Anxiety mean score: 6.9, Stress mean score: 11.6, Total mean score: 22.7). This study assessed sleep continuity using Awakenings per Night (ApN) via a smartwatch (HELO HEALTH®) and conducted the study in two phases: baseline (T0) and after 30 days of treatment (T1) (Phase A). No placebo-control was used in this study. After 30 days (Phase B), 21 patients were selected for reassessment. Eleven continued treatment for another 30 days (T2), while ten discontinued. Following the intervention, we observed remarkable improvements in sleep quality and mental distress. The SPINOFF® supplement significantly reduced the PSQI scores (22.4%), indicating enhanced sleep quality. Additionally, there was a 19.6% decrease in ISI scores, demonstrating a reduction in insomnia symptoms. Moreover, overall psychological distress decreased by 19.5% signifying improved psychological well-being. In the second phase, participants who continued treatment experienced more substantial improvements, with a mean decrease of 0.8 points in PSQI scores (±0.9) and a mean decrease of 0.9 points in ISI scores. Our findings suggest that the SPINOFF® supplement has the potential to effectively address both sleep disturbances and psychological distress in our study population.
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Affiliation(s)
- Matteo De Simone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via Salvatore Allende, 84081 Baronissi, Italy; (R.D.F.); (E.C.)
| | - Rosario De Feo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via Salvatore Allende, 84081 Baronissi, Italy; (R.D.F.); (E.C.)
| | - Anis Choucha
- Department of Neurosurgery, Aix Marseille University, APHM, UH Timone, 13005 Marseille, France;
| | - Elena Ciaglia
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Via Salvatore Allende, 84081 Baronissi, Italy; (R.D.F.); (E.C.)
| | - Francis Fezeu
- Department of Neurology & Neurological Surgery, Brain Global, 27659 Arabian Drive, Salisbury, MD 21801, USA;
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Hoover GL, Whitehair VC. Agitation after traumatic brain injury: a review of current and future concepts in diagnosis and management. Neurol Res 2023; 45:884-892. [PMID: 32706643 DOI: 10.1080/01616412.2020.1797374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Agitation and aggression are common following traumatic brain injury. The challenges related to these disorders affect all stages of recovery, from the acute hospital to the community setting. The aim of this literature review is to provide an updated overview of the current state of post-traumatic agitation research. METHODS We performed a PubMed literature review which included recent confirmatory and novel research as well as classic and historical studies to integrate past and future concepts. RESULTS Areas explored include the personal and societal effects of post-traumatic agitation, methods for defining and diagnosing several neurobehavioral disorders, and pathophysiology and management of agitation and aggression. Target areas for future study are identified and discussed. DISCUSSION While much progress has been made in understanding post-traumatic agitation, there remain several key areas that require further elucidation to support the care and treatment for people with traumatic brain injury.
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Affiliation(s)
- Gary L Hoover
- Department of Physical Medicine and Rehabilitation, MetroHealth System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
| | - Victoria C Whitehair
- Department of Physical Medicine and Rehabilitation, MetroHealth System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
- Cleveland FES Center, Cleveland, OH, USA
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Ryan T, Nagle S, Daly E, Pearce AJ, Ryan L. A Potential Role Exists for Nutritional Interventions in the Chronic Phase of Mild Traumatic Brain Injury, Concussion and Sports-Related Concussion: A Systematic Review. Nutrients 2023; 15:3726. [PMID: 37686758 PMCID: PMC10490336 DOI: 10.3390/nu15173726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
Mild traumatic brain injury (mTBI) represents a significant burden for individuals, economies, and healthcare systems worldwide. Recovery protocols focus on medication and physiotherapy-based interventions. Animal studies have shown that antioxidants, branched-chain amino acids and omega-3 fatty acids may improve neurophysiological outcomes after TBI. However, there appears to be a paucity of nutritional interventions in humans with chronic (≥1 month) symptomology post-mTBI. This systematic literature review aimed to consolidate evidence for nutrition and dietary-related interventions in humans with chronic mTBI. The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42021277780) and conducted following the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three reviewers searched five databases (PubMed/MEDLINE, Web of Science, SPORTDiscus, CINAHL Complete and Cochrane), which yielded 6164 studies. Nine studies met the inclusion criteria. The main finding was the lack of interventions conducted to date, and a quality assessment of the included studies was found to be fair to good. Due to heterogeneity, a meta-analysis was not feasible. The six nutrition areas identified (omega-3 fatty acids, melatonin, Enzogenol®, MLC901, ketogenic diet and phytocannabinoids) were safe and well-tolerated. It was found that these nutritional interventions may improve cognitive failures, sleep disturbances, anxiety, physical disability, systolic blood pressure volume and sport concussion assessment tool scores following mTBI. Potential areas of improvement identified for future studies included blinding, reporting compliance, and controlling for confounders. In conclusion, further research of higher quality is needed to investigate the role of nutrition in recovery from mTBI to reduce the burden of chronic outcomes following mTBI.
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Affiliation(s)
- Tansy Ryan
- Department of Sport Exercise & Nutrition, Atlantic Technological University, Dublin Road, H91 T8NW Galway City, Galway, Ireland; (T.R.); (E.D.)
| | - Sarah Nagle
- Department of Sport Exercise & Nutrition, Atlantic Technological University, Dublin Road, H91 T8NW Galway City, Galway, Ireland; (T.R.); (E.D.)
| | - Ed Daly
- Department of Sport Exercise & Nutrition, Atlantic Technological University, Dublin Road, H91 T8NW Galway City, Galway, Ireland; (T.R.); (E.D.)
| | - Alan J. Pearce
- College of Sport, Health and Engineering, La Trobe University, Plenty Road and Kingsbury Drive, Melbourne, VIC 3086, Australia;
| | - Lisa Ryan
- Department of Sport Exercise & Nutrition, Atlantic Technological University, Dublin Road, H91 T8NW Galway City, Galway, Ireland; (T.R.); (E.D.)
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Shaib F. Neurologic Disorders in Women and Sleep. Neurol Clin 2023; 41:297-314. [PMID: 37030959 DOI: 10.1016/j.ncl.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Sleep disorders in women remain underrecognized and underdiagnosed mainly because of gender bias in researching and characterizing sleep disorders in women. Symptoms of common sleep disorders are frequently missed in the general female population and are expected to be further overlooked because of overlapping symptoms in women with neurologic disorders. Given the bidirectional relationship with sleep and neurologic disorders, it remains critical to be aware of the presentation and impact of sleep disorders in this patient population. This article reviews available data on sleep disorders in women with neurologic disorders and discusses their distinctive features.
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Affiliation(s)
- Fidaa Shaib
- Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, McNair Campus, 7200 Cambridge Street, Houston, TX 77030, USA.
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11
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Bell A, Hewins B, Bishop C, Fortin A, Wang J, Creamer JL, Collen J, Werner JK. Traumatic Brain Injury, Sleep, and Melatonin-Intrinsic Changes with Therapeutic Potential. Clocks Sleep 2023; 5:177-203. [PMID: 37092428 PMCID: PMC10123665 DOI: 10.3390/clockssleep5020016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
Traumatic brain injury (TBI) is one of the most prevalent causes of morbidity in the United States and is associated with numerous chronic sequelae long after the point of injury. One of the most common long-term complaints in patients with TBI is sleep dysfunction. It is reported that alterations in melatonin follow TBI and may be linked with various sleep and circadian disorders directly (via cellular signaling) or indirectly (via free radicals and inflammatory signaling). Work over the past two decades has contributed to our understanding of the role of melatonin as a sleep regulator and neuroprotective anti-inflammatory agent. Although there is increasing interest in the treatment of insomnia following TBI, a lack of standardization and rigor in melatonin research has left behind a trail of non-generalizable data and ambiguous treatment recommendations. This narrative review describes the underlying biochemical properties of melatonin as they are relevant to TBI. We also discuss potential benefits and a path forward regarding the therapeutic management of TBI with melatonin treatment, including its role as a neuroprotectant, a somnogen, and a modulator of the circadian rhythm.
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Affiliation(s)
- Allen Bell
- Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Bryson Hewins
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (B.H.)
| | - Courtney Bishop
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (B.H.)
| | - Amanda Fortin
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (B.H.)
| | - Jonathan Wang
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (B.H.)
| | | | - Jacob Collen
- Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (B.H.)
| | - J. Kent Werner
- Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (B.H.)
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12
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Mehrpooya M, Mazdeh M, Rahmani E, Khazaie M, Ahmadimoghaddam D. Melatonin supplementation may benefit patients with acute ischemic stroke not eligible for reperfusion therapies: Results of a pilot study. J Clin Neurosci 2022; 106:66-75. [DOI: 10.1016/j.jocn.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
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13
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Jacquens A, Needham EJ, Zanier ER, Degos V, Gressens P, Menon D. Neuro-Inflammation Modulation and Post-Traumatic Brain Injury Lesions: From Bench to Bed-Side. Int J Mol Sci 2022; 23:ijms231911193. [PMID: 36232495 PMCID: PMC9570205 DOI: 10.3390/ijms231911193] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Head trauma is the most common cause of disability in young adults. Known as a silent epidemic, it can cause a mosaic of symptoms, whether neurological (sensory-motor deficits), psychiatric (depressive and anxiety symptoms), or somatic (vertigo, tinnitus, phosphenes). Furthermore, cranial trauma (CT) in children presents several particularities in terms of epidemiology, mechanism, and physiopathology-notably linked to the attack of an immature organ. As in adults, head trauma in children can have lifelong repercussions and can cause social and family isolation, difficulties at school, and, later, socio-professional adversity. Improving management of the pre-hospital and rehabilitation course of these patients reduces secondary morbidity and mortality, but often not without long-term disability. One hypothesized contributor to this process is chronic neuroinflammation, which could accompany primary lesions and facilitate their development into tertiary lesions. Neuroinflammation is a complex process involving different actors such as glial cells (astrocytes, microglia, oligodendrocytes), the permeability of the blood-brain barrier, excitotoxicity, production of oxygen derivatives, cytokine release, tissue damage, and neuronal death. Several studies have investigated the effect of various treatments on the neuroinflammatory response in traumatic brain injury in vitro and in animal and human models. The aim of this review is to examine the various anti-inflammatory therapies that have been implemented.
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Affiliation(s)
- Alice Jacquens
- Unité de Neuroanesthésie-Réanimation, Hôpital de la Pitié Salpêtrière 43-87, Boulevard de l’Hôpital, F-75013 Paris, France
- Inserm, Maladies Neurodéveloppementales et Neurovasculaires, Université Paris Cité, F-75019 Paris, France
- Correspondence: ; Tel.: +33-1-42-16-00-00
| | - Edward J. Needham
- Division of Anaesthesia, Addenbrooke’s Hospital, University of Cambridge, Box 93, Hills Road, Cambridge CB2 2QQ, UK
| | - Elisa R. Zanier
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Vincent Degos
- Unité de Neuroanesthésie-Réanimation, Hôpital de la Pitié Salpêtrière 43-87, Boulevard de l’Hôpital, F-75013 Paris, France
- Inserm, Maladies Neurodéveloppementales et Neurovasculaires, Université Paris Cité, F-75019 Paris, France
| | - Pierre Gressens
- Inserm, Maladies Neurodéveloppementales et Neurovasculaires, Université Paris Cité, F-75019 Paris, France
| | - David Menon
- Division of Anaesthesia, Addenbrooke’s Hospital, University of Cambridge, Box 93, Hills Road, Cambridge CB2 2QQ, UK
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14
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Sanchez E, Blais H, Duclos C, Arbour C, Van Der Maren S, El-Khatib H, Baril AA, Bernard F, Carrier J, Gosselin N. Sleep from acute to chronic traumatic brain injury and cognitive outcomes. Sleep 2022; 45:zsac123. [PMID: 35640250 PMCID: PMC9366647 DOI: 10.1093/sleep/zsac123] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/13/2022] [Indexed: 09/29/2023] Open
Abstract
STUDY OBJECTIVES Traumatic brain injuries (TBIs) cause persistent cerebral damage and cognitive deficits. Because sleep may be a critical factor for brain recovery, we characterized the sleep of patients with TBI from early hospitalization to years post-injury and explored the hypothesis that better sleep during hospitalization predicts more favorable long-term cognitive outcomes. METHODS We tested patients with moderate-to-severe TBI in the hospitalized (n = 11) and chronic (n = 43) stages using full-night polysomnography, with 82% of the hospitalized group being retested years post-injury. Hospitalized patients with severe orthopedic and/or spinal cord injury (n = 14) and healthy participants (n = 36) were tested as controls for the hospitalized and chronic TBI groups, respectively. Groups had similar age and sex and were compared for sleep characteristics, including slow waves and spindles. For patients with TBI, associations between sleep during hospitalization and long-term memory and executive function were assessed. RESULTS Hospitalized patients with TBI or orthopedic injuries had lower sleep efficiency, higher wake after sleep onset, and lower spindle density than the chronic TBI and healthy control groups, but only hospitalized patients with brain injury had an increased proportion of slow-wave sleep. During hospitalization for TBI, less fragmented sleep, more slow-wave sleep, and higher spindle density were associated to more favorable cognitive outcomes years post-injury, while injury severity markers were not associated with these outcomes. CONCLUSION These findings highlight the importance of sleep following TBI, as it could be a strong predictor of neurological recovery, either as a promoter or an early marker of cognitive outcomes.
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Affiliation(s)
- Erlan Sanchez
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et Services Sociaux du Nord de l’Île-de-Montréal, Montreal, Quebec, Canada
- Department of Neuroscience, Université de Montréal, Montreal, Quebec, Canada
| | - Hélène Blais
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et Services Sociaux du Nord de l’Île-de-Montréal, Montreal, Quebec, Canada
| | - Catherine Duclos
- Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Caroline Arbour
- Centre Intégré de Traumatologie, Centre Intégré Universitaire de Santé et Services Sociaux du Nord de l’Île-de-Montréal, Montreal, Quebec, Canada
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - Solenne Van Der Maren
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et Services Sociaux du Nord de l’Île-de-Montréal, Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Héjar El-Khatib
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et Services Sociaux du Nord de l’Île-de-Montréal, Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Andrée-Ann Baril
- Douglas Mental Health University Institute, Montréal, Quebec, Canada
- Department of Psychiatry, McGill University, Montréal, Quebec, Canada
| | - Francis Bernard
- Centre Intégré de Traumatologie, Centre Intégré Universitaire de Santé et Services Sociaux du Nord de l’Île-de-Montréal, Montreal, Quebec, Canada
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et Services Sociaux du Nord de l’Île-de-Montréal, Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et Services Sociaux du Nord de l’Île-de-Montréal, Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
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15
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Effects of melatonin supplementation on BDNF concentrations and depression: A systematic review and meta-analysis of randomized controlled trials. Behav Brain Res 2022; 436:114083. [DOI: 10.1016/j.bbr.2022.114083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/23/2022]
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16
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Ali A, Morfin J, Mills J, Pasipanodya EC, Maas YJ, Huang E, Dirlikov B, Englander J, Zedlitz A. Fatigue After Traumatic Brain Injury: A Systematic Review. J Head Trauma Rehabil 2022; 37:E249-E257. [PMID: 34354018 DOI: 10.1097/htr.0000000000000710] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide a systematic review of published interventions for posttraumatic brain injury fatigue (PTBIF). METHODS PubMed and OneSearch were systematically searched for PTBIF interventions published between January 1, 1989, and March 31, 2019. Search results were evaluated for inclusion based on an abstract and full-text review. Inclusion criteria were (1) an investigation of an intervention, (2) participant sample including individuals with traumatic brain injury (TBI), (3) report of fatigue outcome data among individuals with TBI, and (4) articles available in English, Spanish, French, German, Afrikaans, or Dutch. A risk of bias assessment was conducted on all included publications. RESULTS The search resulted in 2343 publications, with 37 meeting inclusion criteria for this review. Categories of PTBIF interventions were pharmacological ( n = 13), psychological ( n = 9), exercise-based ( n = 4), complementary alternative medicine ( n = 5), electrotherapeutic ( n = 3), and multimodal ( n = 3). Only methylphenidate, modafinil, and cognitive behavioral therapy interventions included multiple cohorts. Pharmacological and psychological interventions represented the groups with the lowest risk of bias. CONCLUSIONS This review includes 37 studies, with 21 studies published after 2014. Methylphenidate and melatonin were the only pharmacological agents found to reduce fatigue in randomized controlled trials. Creatine given to children prospectively at onset of injury reduced fatigue at follow-up. Walking and water aerobics were effective exercise interventions in isolated randomized controlled studies. One multimodal study of children after concussion was more effective at reducing fatigue and postconcussion symptoms than community standard of care. Other interventions had equivocal results. Overall, more work remains to understand and develop treatments for PTBIF.
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Affiliation(s)
- Arshad Ali
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California (Messrs Ali and Dirlikov, Ms Morfin, and Dr Pasipanodya); Medical Library, Santa Clara Valley Medical Center, San Jose, California (Ms Mills); SeneCure, GGZ-Breburg, Tilburg, the Netherlands (Ms Maas); Physical Medicine and Rehabilitation Department, Santa Clara Valley Medical Center, San Jose, California (Drs Huang and Englander); Department of Orthopedic Surgery, Stanford University School of Medicine, Palo Alto, California (Dr Englander); and Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands (Dr Zedlitz)
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17
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Denisova NP, Rzaev JA. Psychiatric mimics of neurosurgical disorders. PROGRESS IN BRAIN RESEARCH 2022; 272:153-171. [PMID: 35667800 DOI: 10.1016/bs.pbr.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Every year there are about 22.6 million people in need of neurosurgical care around the world, and one or several interventions are required to save lives and restore functional losses in more than half of these cases (13.8 million). Most neurosurgical interventions are performed in patients with traumatic brain and spinal cord injuries, strokes, central nervous system (CNS) tumors, hydrocephalus, and epilepsy. In addition to neurological symptoms, many CNS disorders are often accompanied by cognitive and/or behavioral changes. Physical and psychological symptoms can be intertwined as follows: 1) neurological symptoms may be manifested as a result of complex psychological processes; 2) psychological disorders may be manifested as neurological symptoms; 3) neurological disorders commonly cause secondary psychological responses; 4) psychological disorder may be induced more or less directly by an organic brain disease. In the present paper, we focus on the psychiatric conditions occurring in the patients with neurosurgical disorders who either get prepared for surgery or have already received it.
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Affiliation(s)
| | - Jamil A Rzaev
- Federal Neurosurgical Center, Novosibirsk, Russian Federation.
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18
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Sleep Disturbances Following Traumatic Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00351-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Leelaviwat N, Mekraksakit P, Cross KM, Landis DM, McLain M, Sehgal L, Payne JD. Melatonin: Translation of Ongoing Studies Into Possible Therapeutic Applications Outside Sleep Disorders. Clin Ther 2022; 44:783-812. [DOI: 10.1016/j.clinthera.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 12/14/2022]
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20
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Treating sleep disorders following traumatic brain injury in adults: time for renewed effort? Sleep Med Rev 2022; 63:101631. [DOI: 10.1016/j.smrv.2022.101631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 11/21/2022]
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21
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Gao C, Nie M, Huang J, Tian Y, Wang D, Zhang J, Jiang R. Pharmacotherapy for mild traumatic brain injury: an overview of the current treatment options. Expert Opin Pharmacother 2022; 23:805-813. [PMID: 35290753 DOI: 10.1080/14656566.2022.2054328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Accounting for 90% of all traumatic brain injuries (TBIs), mild traumatic brain injury (mTBI) is currently the most frequently seen type of TBI. Although most patients can recover from mTBI, some may suffer from prolonged symptoms for months to years after injury. Growing evidence indicates that mTBI is associated with neurodegenerative diseases including dementias and Parkinson's disease (PD). Pharmacological interventions are necessary to address the symptoms and avoid the adverse consequences of mTBI. AREAS COVERED To provide an overview of the current treatment options, the authors herein review the potential drugs to reduce the secondary damage and symptom-targeted therapy as well as the ongoing clinical trials about pharmacotherapy for mTBI. EXPERT OPINION There has been no consensus on the pharmacotherapy for mTBI. Several candidates including n-3 PUFAs, melatonin, NAC and statins show potential benefits in lessening the secondary injury and improving neurological deficits in pre-clinic studies, which, however, still need further investigation in clinical trials. The current pharmacotherapy for mTBI is empirical in nature and mainly targets to mitigate the symptoms. Well-designed clinical trials are now warranted to provide high level evidence.
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Affiliation(s)
- Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China.,Key Laboratory of Post -Neuroinjury Neuro -repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin, China
| | - Meng Nie
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China.,Key Laboratory of Post -Neuroinjury Neuro -repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin, China
| | - Jinhao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China.,Key Laboratory of Post -Neuroinjury Neuro -repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin, China
| | - Ye Tian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China.,Key Laboratory of Post -Neuroinjury Neuro -repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin, China
| | - Dong Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China.,Key Laboratory of Post -Neuroinjury Neuro -repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin, China
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China.,Key Laboratory of Post -Neuroinjury Neuro -repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin, China
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China.,Key Laboratory of Post -Neuroinjury Neuro -repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin, China
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22
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Pereira GA, Gomes Domingos AL, Aguiar ASD. Relationship between food consumption and improvements in circulating melatonin in humans: an integrative review. Crit Rev Food Sci Nutr 2022; 62:670-678. [DOI: 10.1080/10408398.2020.1825924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Gabriela Amorim Pereira
- Faculty of Medicine, Department of Collective Health, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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23
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Ashrafizadeh M, Ahmadi Z, Yaribeygi H, Sathyapalan T, Jamialahmadi T, Sahebkar A. Antitumor and Protective Effects of Melatonin: The Potential Roles of MicroRNAs. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1328:463-471. [PMID: 34981497 DOI: 10.1007/978-3-030-73234-9_31] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
MicroRNAs (miRNAs) are endogenous short noncoding RNAs with approximately 22 nucleotides. The primary function of miRNAs is the negative regulation of target gene expression via mRNA degradation or translation inhibition. During recent years, much attention has been made toward miRNAs' role in different disorders; particularly cancer and compounds with modulatory effects on miRNAs are of interest. Melatonin is one of these compounds which is secreted by the pineal gland. Also, melatonin is present in the leaves, fruits, and seeds of plants. Melatonin has several valuable biological activities such as antioxidant, anti-inflammation, antitumor, and antiaging activities. This important agent is extensively used to treat different disorders such as cancer and neurodegenerative and cardiovascular diseases. This review aims to describe the modulatory effect of melatonin on miRNAs as novel targets.
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Affiliation(s)
- Milad Ashrafizadeh
- Faculty of Engineering and Natural Sciences, Sabanci University, Istanbul, Turkey.,Sabanci University Nanotechnology Research and Application Center (SUNUM), Istanbul, Turkey
| | - Zahra Ahmadi
- Department of Basic Science, Faculty of Veterinary Medicine, Islamic Azad Branch, University of Shushtar, Shushtar, Khuzestan, Iran
| | - Habib Yaribeygi
- Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran.
| | - Thozhukat Sathyapalan
- Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, United Kingdom of Great Britain and Northern Ireland, Hull, UK
| | - Tannaz Jamialahmadi
- Department of Food Science and Technology, Quchan Branch, Islamic Azad University, Quchan, Iran.,Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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24
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Li C, Ma D, Li M, Wei T, Zhao X, Heng Y, Ma D, Anto EO, Zhang Y, Niu M, Zhang W. The Therapeutic Effect of Exogenous Melatonin on Depressive Symptoms: A Systematic Review and Meta-Analysis. Front Psychiatry 2022; 13:737972. [PMID: 35370838 PMCID: PMC8968118 DOI: 10.3389/fpsyt.2022.737972] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 02/17/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Depression-related mortality and morbidity pose growing public health burdens worldwide. Although the therapeutic effect of exogenous melatonin on depression has been investigated, findings remain inconsistent. We conducted this systematic review and meta-analysis to clarify the effectiveness of melatonin in the treatment of depression, including primary and secondary depression symptoms. METHODS We searched the online databases of PubMed, EMBASE, and the Cochrane Library for original studies published up to May 2021. We used STATA 14.0 software to synthesize the results of included studies. To evaluate the effectiveness of melatonin, we calculated the standardized mean differences (SMDs) and 95% confidence intervals (CIs) of depression scores between the melatonin and placebo groups. RESULTS Our literature search returned 754 publications, among which 19 studies with 1,178 patients (715 women, 463 men; mean age: 56.77 years) met inclusion criteria. Melatonin dosages ranged from 2 to 25 mg per day; treatment durations were between 10 days and 3.5 years. Our synthesized results showed that melatonin was not found significantly beneficial for alleviating depressive symptoms (SMD = -0.17, 95% CI = [-0.38, 0.05]). Subgroup analysis demonstrated that the decrease in depression scores measured with the Beck Depression Inventory (BDI) was significant (SMD = -0.52, 95% CI = [-0.73, -0.31]). CONCLUSIONS There is very limited evidence for effects of melatonin on depression.
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Affiliation(s)
- Cancan Li
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China.,Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Dandan Ma
- The Second Affiliated Hospital of Shandong First Medical University, Taian, China.,School of Basic Medical Science, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Min Li
- Department of Medical Image, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Medical Image, Taian City Central Hospital, Taian, China
| | - Tao Wei
- School of Basic Medical Science, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Xuan Zhao
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Yuanyuan Heng
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Delong Ma
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Enoch Odame Anto
- College of Health Sciences, Department of Medical Diagnostic, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Yanbo Zhang
- The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Mingyun Niu
- The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Wangxin Zhang
- School of Basic Medical Science, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
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25
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Effect of melatonin supplementation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. J Neurol 2022; 269:205-216. [PMID: 33417003 DOI: 10.1007/s00415-020-10381-w] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Present study was conducted to systematically review the effect of the melatonin on sleep quality. We summarized evidence from randomized clinical trials (RCTs) that investigated the effects of melatonin on sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI) in adults with various diseases. METHODS The literature searches of English publications in MEDLINE and EMBASE databases were performed up June 2020. Results were summarized as mean differences (MD) with 95% confidence intervals (CI) using random effects model (DerSimonian-Laird method). Heterogeneity among studies was evaluated by the Cochrane Q test and I-squared (I2). To determine the predefined sources of heterogeneity, subgroup analysis was performed. RESULTS Of 2642 papers, 23 RCTs met inclusion criteria. Our results indicated that melatonin had significant effect on sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI) (WMD: - 1.24; 95% CI - 1.77, - 0.71, p = 0.000). There was significant heterogeneity between studies (I2 = 80.7%, p = 0.000). Subgroup analysis based on health status and kind of intervention were potential between-study heterogeneity. Subgroup analysis based on health status revealed melatonin intervention in subjects with Respiratory diseases (WMD: - 2.20; 95% CI - 2.97, - 1.44, p = 0.000), Metabolic disorders (WMD: - 2.74; 95% CI - 3.48, - 2.00, p = 0.000) and sleep disorders (WMD: - 0.67; 95% CI - 0.98, - 0.37, p = 0.000) has significant effect on sleep quality. CONCLUSION We found that the treatment with exogenous melatonin has positive effects on sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI) in adult. In adults with respiratory diseases, metabolic disorders, primary sleep disorders, not with mental disorders, neurodegenerative diseases and other diseases.
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Falco C, Barton C. Melatonin administration for sleep disorders in traumatic brain injury: A review of the literature. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2022. [DOI: 10.4103/jisprm.jisprm-000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Parker TD, Rees R, Rajagopal S, Griffin C, Goodliffe L, Dilley M, Jenkins PO. Post-traumatic amnesia. Pract Neurol 2021; 22:129-137. [PMID: 34906998 DOI: 10.1136/practneurol-2021-003056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 11/03/2022]
Abstract
Post-traumatic amnesia is the transient state of altered brain function that may follow a traumatic brain injury. At a practical level, an individual has emerged from post-traumatic amnesia when he or she is fully orientated and with return of continuous memory. However, the clinical manifestations are often more complex, with numerous cognitive domains commonly affected, as well as behaviour. In the acute setting, post-traumatic amnesia may easily go unrecognised; this is problematic as it has important implications for both immediate management and for longer-term prognosis. We therefore recommend its careful clinical assessment and prospective evaluation using validated tools. Patients in post-traumatic amnesia who have behavioural disturbance can be particularly challenging to manage. Behavioural and environmental measures form the mainstay of its treatment while avoiding pharmacological interventions where possible, as they may worsen agitation. Patients need assessing regularly to determine their need for further rehabilitation and to facilitate safe discharge planning.
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Affiliation(s)
- Thomas D Parker
- Atkinson Morley Neuroscience Unit, St George's University Hospitals NHS Foundation Trust, London, UK.,Department of Brain Sciences, Imperial College London, London, UK
| | - Richard Rees
- Atkinson Morley Neuroscience Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sangeerthana Rajagopal
- Atkinson Morley Neuroscience Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Colette Griffin
- Atkinson Morley Neuroscience Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Luke Goodliffe
- Atkinson Morley Neuroscience Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Michael Dilley
- Atkinson Morley Neuroscience Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Peter Owen Jenkins
- Atkinson Morley Neuroscience Unit, St George's University Hospitals NHS Foundation Trust, London, UK
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Ikram M, Park HY, Ali T, Kim MO. Melatonin as a Potential Regulator of Oxidative Stress, and Neuroinflammation: Mechanisms and Implications for the Management of Brain Injury-Induced Neurodegeneration. J Inflamm Res 2021; 14:6251-6264. [PMID: 34866924 PMCID: PMC8637421 DOI: 10.2147/jir.s334423] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/15/2021] [Indexed: 12/29/2022] Open
Abstract
This review covers the preclinical and clinical literature supporting the role of melatonin in the management of brain injury-induced oxidative stress, neuroinflammation, and neurodegeneration, and reviews the past and current therapeutic strategies. Traumatic brain injury (TBI) is a neurodegenerative condition, unpredictably and potentially progressing into chronic neurodegeneration, with permanent cognitive, neurologic, and motor dysfunction, having no standard therapies. Due to its complex and multi-faceted nature, the TBI has highly heterogeneous pathophysiology, characterized by the highest mortality and disability worldwide. Mounting evidence suggests that the TBI induces oxidative and nitrosative stress, which is involved in the progression of chronic and acute neurodegenerative diseases. Defenses against such conditions are mostly dependent on the usage of antioxidant compounds, the majority of whom are ingested as nutraceuticals or as dietary supplements. A large amount of literature is available regarding the efficacy of antioxidant compounds to counteract the TBI-associated damage in animal and cellular models of the TBI and several clinical studies. Collectively, the studies have suggested that TBI induces oxidative stress, by suppressing the endogenous antioxidant system, such as nuclear factor erythroid 2–related factor-2 (Nrf-2) increasing the lipid peroxidation and elevation of oxidative damage. Moreover, elevated oxidative stress may induce neuroinflammation by activating the microglial cells, releasing and activating the inflammatory cytokines and inflammatory mediators, and energy dyshomeostasis. Thus, melatonin has shown regulatory effects against the TBI-induced autophagic dysfunction, regulation of mitogen-activated protein kinases, such as ERK, activation of the NLRP-3 inflammasome, and release of the inflammatory cytokines. The collective findings strongly suggest that melatonin may regulate TBI-induced neurodegeneration, although further studies should be conducted to better facilitate future therapeutic windows.
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Affiliation(s)
- Muhammad Ikram
- Division of Life Science and Applied Life Science (BK21 Four), College of Natural Sciences, Gyeongsang National University, Jinju, 52828, Republic of Korea
| | - Hyun Young Park
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, 6202 AZ, the Netherlands.,School for Mental Health and Neuroscience (MHeNS), Maastricht Medical Center, Maastricht, 6229 ER, the Netherlands
| | - Tahir Ali
- Division of Life Science and Applied Life Science (BK21 Four), College of Natural Sciences, Gyeongsang National University, Jinju, 52828, Republic of Korea
| | - Myeong Ok Kim
- Division of Life Science and Applied Life Science (BK21 Four), College of Natural Sciences, Gyeongsang National University, Jinju, 52828, Republic of Korea.,Alz-Dementia Korea Co., Jinju, 52828, Republic of Korea
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Dong CH, Gao CN, An XH, Li N, Yang L, Li DC, Tan Q. Nocturnal dexmedetomidine alleviates post-intensive care syndrome following cardiac surgery: a prospective randomized controlled clinical trial. BMC Med 2021; 19:306. [PMID: 34865637 PMCID: PMC8647374 DOI: 10.1186/s12916-021-02175-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dexmedetomidine is a sedative agent that may have the potential to reduce the risk of post-intensive care syndrome (PICS). This study aimed to establish whether prophylactic nocturnal dexmedetomidine safely reduces postoperative PICS incidence and to develop an easy-to-use model for predicting the risk of PICS following cardiac surgery. METHODS This was a single-center, double-blind, randomized, prospective, placebo-controlled trial. Patients undergoing cardiac surgery were randomly assigned (1:1) to dexmedetomidine or placebo (normal saline) groups between January 2019 and July 2020. Dexmedetomidine or a similar volume of saline was administered, with an infusion rate up to 1.2 μg/kg/h until the RASS remained between - 1 and 0. The primary study endpoint was PICS incidence at 6 months follow-up, as defined by cognitive, physical, or psychological impairments. RESULTS We assessed 703 individuals for eligibility, of whom 508 were enrolled. Of these, there were 251 in the dexmedetomidine group and 257 in the placebo group that received the trial agent, forming a modified intention-to-treat population. PICS incidence at 6-month follow-up was significantly decreased in the dexmedetomidine group (54/251, 21.5%) relative to the placebo group (80/257, 31.1%) (odds ratio [OR] 0.793, 95% CI 0.665-0.945; p = 0.014). Psychological impairment was significantly reduced in the dexmedetomidine group relative to the placebo group (18.7% vs. 26.8%, OR 0.806, CI 0.672-0.967, p = 0.029). However, dexmedetomidine treatment was associated with a higher rate of hypotension. A nomogram revealed that age, education, a medical history of diabetes and smoking, dexmedetomidine treatment, postoperative atrial fibrillation, and sequential organ failure assessment scores at 8 h post-surgery were independent predictors of PICS. CONCLUSIONS Prophylactic nocturnal dexmedetomidine administration significantly reduced PICS incidence by a marked reduction in psychological impairment within a 6-month follow-up period. TRIAL REGISTRATION ChiCTR, ChiCTR1800014314 . Registered 5 January 2018, http://www.chictr.org.cn/index.aspx.
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Affiliation(s)
- Chun-hui Dong
- Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi Road, Jinan, 250021 Shandong China
| | - Chao-nan Gao
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China
- Healthcare Big Data Institute of Shandong University, Jinan, 250000 Shandong China
| | - Xiao-hua An
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - Na Li
- Department of Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - Le Yang
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - De-cai Li
- Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi Road, Jinan, 250021 Shandong China
| | - Qi Tan
- Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi Road, Jinan, 250021 Shandong China
- Department of Cardiac Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021 Shandong China
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Köhli P, Otto E, Jahn D, Reisener MJ, Appelt J, Rahmani A, Taheri N, Keller J, Pumberger M, Tsitsilonis S. Future Perspectives in Spinal Cord Repair: Brain as Saviour? TSCI with Concurrent TBI: Pathophysiological Interaction and Impact on MSC Treatment. Cells 2021; 10:2955. [PMID: 34831179 PMCID: PMC8616497 DOI: 10.3390/cells10112955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/08/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022] Open
Abstract
Traumatic spinal cord injury (TSCI), commonly caused by high energy trauma in young active patients, is frequently accompanied by traumatic brain injury (TBI). Although combined trauma results in inferior clinical outcomes and a higher mortality rate, the understanding of the pathophysiological interaction of co-occurring TSCI and TBI remains limited. This review provides a detailed overview of the local and systemic alterations due to TSCI and TBI, which severely affect the autonomic and sensory nervous system, immune response, the blood-brain and spinal cord barrier, local perfusion, endocrine homeostasis, posttraumatic metabolism, and circadian rhythm. Because currently developed mesenchymal stem cell (MSC)-based therapeutic strategies for TSCI provide only mild benefit, this review raises awareness of the impact of TSCI-TBI interaction on TSCI pathophysiology and MSC treatment. Therefore, we propose that unravelling the underlying pathophysiology of TSCI with concomitant TBI will reveal promising pharmacological targets and therapeutic strategies for regenerative therapies, further improving MSC therapy.
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Affiliation(s)
- Paul Köhli
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Ellen Otto
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Denise Jahn
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Marie-Jacqueline Reisener
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
| | - Jessika Appelt
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Adibeh Rahmani
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Nima Taheri
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
| | - Johannes Keller
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany;
- University Hospital Hamburg-Eppendorf, Department of Trauma Surgery and Orthopaedics, Martinistraße 52, 20246 Hamburg, Germany
| | - Matthias Pumberger
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany;
| | - Serafeim Tsitsilonis
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; (P.K.); (E.O.); (D.J.); (M.-J.R.); (J.A.); (A.R.); (N.T.)
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany;
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Lorente L, Martín MM, Ruiz C, Abreu-González P, Ramos-Gómez L, Argueso M, Sole-Violan J, Cáceres JJ, Jiménez A. Serum melatonin levels in predicting mortality in patients with severe traumatic brain injury. Anaesth Crit Care Pain Med 2021; 40:100966. [PMID: 34718184 DOI: 10.1016/j.accpm.2021.100966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/22/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE A secondary brain injury could appear after traumatic brain injury (TBI) due to neuroinflammation, oxidation and apoptosis. Higher levels of serum melatonin have been found on admission for TBI in non-surviving than in surviving patients. Thus, the objective of this study was to know serum melatonin levels during the first week of TBI in surviving and non-surviving patients, and to know if serum melatonin levels during the first week of TBI can be used to predict mortality. METHODS Patients with an isolated and severe TBI were included; that is, if they scored < 10 points in non-cranial aspects of Injury Severity Score and < 9 points in the Glasgow Coma Scale. We measured serum melatonin concentrations at days 1, 4 and 8 of TBI. Thirty-day mortality was the end-point study. RESULTS Lower serum melatonin levels were found in the surviving patients (n = 90) than in the non-survivors (n = 34) on days 1 (p < 0.001), 4 (p < 0.001), and 8 (p = 0.02) of TBI. Serum melatonin concentrations on days 1, 4, and 8 of TBI had an area under curve (95% Confidence Interval) for the prediction of 30-day mortality of 0.85 (0.77-0.91; p < 0.001), 0.82 (0.74-0.89; p < 0.001) and 0.71 (0.61-0.79; p = 0.06) respectively. CONCLUSIONS The new findings of this study were the presence of higher levels of serum melatonin on days 1, 4 and 8 of TBI in non-survivors than in survivors, and the ability to predict 30-day mortality for serum melatonin levels measured at these time points. However, more research is necessary to confirm our results.
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Affiliation(s)
- Leonardo Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n, La Laguna, Santa Cruz de Tenerife, 38320, Spain.
| | - María M Martín
- Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n, Santa Cruz de Tenerife, 38010, Spain
| | - Candelaria Ruiz
- Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n, Santa Cruz de Tenerife, 38010, Spain
| | - Pedro Abreu-González
- Department of Physiology, Faculty of Medicine, University of the La Laguna, Ofra s/n, La Laguna, Santa Cruz de Tenerife, 38320, Spain
| | - Luis Ramos-Gómez
- Intensive Care Unit, Hospital General La Palma, Buenavista de Arriba s/n, Breña Alta, La Palma, 38713, Spain
| | - Mónica Argueso
- Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibáñez nº17-19, Valencia, 46004, Spain
| | - Jordi Sole-Violan
- Intensive Care Unit, Hospital Universitario Dr. Negrín, CIBERES, Barranco de la Ballena s/n, Las Palmas de Gran Canaria, 35010, Spain
| | - Juan J Cáceres
- Intensive Care Unit, Hospital Insular, Plaza Dr, Pasteur s/n, Las Palmas de Gran Canaria, 35016, Spain
| | - Alejandro Jiménez
- Research Unit, Hospital Universitario de Canarias, Ofra s/n, La Laguna, Santa Cruz de Tenerife, 38320, Spain
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Blue-Enriched White Light Therapy Reduces Fatigue in Survivors of Severe Traumatic Brain Injury: A Randomized Controlled Trial. J Head Trauma Rehabil 2021; 35:E78-E85. [PMID: 31246878 DOI: 10.1097/htr.0000000000000500] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Fatigue is one of the disabling sequelae of traumatic brain injury (TBI), with repercussions on quality of life, rehabilitation, and professional reintegration. Research is needed on effective interventions. We evaluated efficacy of blue-enriched white light (BWL) therapy on fatigue of patients with severe TBI. SETTING Physical Medicine and Rehabilitation and Physiology departments of University hospitals. PARTICIPANTS Adult patients with fatigue symptoms following severe TBI, Fatigue Severity Scale (FSS) score 4 or more, Epworth Sleepiness Scale (ESS) score 10 or more, and/or Pittsburgh Sleep Quality Index (PSQI]) more than 5 were randomly assigned to one of 2 parallel groups: a BWL therapy group, with 30-minute exposure to waking white light enriched with blue for 4 weeks, and a group without light therapy (N-BWL), no light. DESIGN Randomized controlled trial. ClinicalTrials.gov number: NCT02420275. MAIN MEASURES The primary outcome measure was the response of the FSS to 4 weeks of treatment. In addition, we assessed latency change of the P300 component of event-related potentials before and after therapy. RESULTS Significant improvement in the FSS score (P = .026) was found in the BWL group compared with the N-BWL group. CONCLUSION BWL phototherapy reduces fatigue in patients with severe TBI.
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Connolly LJ, Rajaratnam SMW, Spitz G, Lockley SW, Ponsford JL. Factors Associated With Response to Pilot Home-Based Light Therapy for Fatigue Following Traumatic Brain Injury and Stroke. Front Neurol 2021; 12:651392. [PMID: 34335435 PMCID: PMC8319544 DOI: 10.3389/fneur.2021.651392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Fatigue and sleep disturbance are common and debilitating problems after brain injury. Light therapy shows promise as a potential treatment. We conducted a trial of in-home light therapy to alleviate fatigue and sleep disturbance. The aim of the current study was to identify factors moderating treatment response. Methods: Participants were 24 individuals with traumatic brain injury (TBI) (n = 19) or stroke (n = 5) reporting clinically significant fatigue. Outcomes included fatigue on Brief Fatigue Inventory (primary outcome), sleep disturbance on Pittsburgh Sleep Quality Index, reaction time (RT) on Psychomotor Vigilance Task and time spent in productive activity. Interactions of demographic and clinical variables with these outcomes were examined in linear mixed-model analyses. Results: Whilst there were no variables found to be significantly associated with change in our primary outcome of fatigue, some variables revealed medium or large effect sizes, including chronotype, eye color, injury severity as measured by PTA, and baseline depressive symptoms. Chronotype significantly moderated sleep quality, with evening chronotype being associated with greater improvement during treatment. Injury type significantly predicted mean RT, with stroke participants exhibiting greater post-treatment reduction than TBI. Age significantly predicted productive activity during Treatment, with younger participants showing stronger Treatment effect. Conclusion: Light therapy may have a greater impact on sleep in younger individuals and those with an evening chronotype. Older individuals may need higher treatment dose to achieve benefit. Clinical Trial Registration:www.anzctr.org.au, identifier: ACTRN12617000866303.
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Affiliation(s)
- Laura J Connolly
- Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia.,School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Shantha M W Rajaratnam
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Gershon Spitz
- Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia.,School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Steven W Lockley
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Jennie L Ponsford
- Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia.,School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
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Connolly LJ, Rajaratnam SMW, Murray JM, Spitz G, Lockley SW, Ponsford JL. Home-based light therapy for fatigue following acquired brain injury: a pilot randomized controlled trial. BMC Neurol 2021; 21:262. [PMID: 34225698 PMCID: PMC8256500 DOI: 10.1186/s12883-021-02292-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Fatigue and sleep disturbance are debilitating problems following brain injury and there are no established treatments. Building on demonstrated efficacy of blue light delivered via a lightbox in reducing fatigue and daytime sleepiness after TBI, this study evaluated the efficacy of a novel in-home light intervention in alleviating fatigue, sleep disturbance, daytime sleepiness and depressive symptoms, and in improving psychomotor vigilance and participation in daily productive activity, following injury METHODS: The impact of exposure to a dynamic light intervention (Treatment) was compared to usual lighting (Control) in a randomized within-subject, crossover trial. Outcomes were fatigue (primary outcome), daytime sleepiness, sleep disturbance, insomnia symptoms, psychomotor vigilance, mood and activity levels. Participants (N = 24, M ± SDage = 44.3 ± 11.4) had mild-severe TBI or stroke > 3 months previously, and self-reported fatigue (Fatigue Severity Scale ≥ 4). Following 2-week baseline, participants completed each condition for 2 months in counter-balanced order, with 1-month follow-up. Treatment comprised daytime blue-enriched white light (CCT > 5000 K) and blue-depleted light (< 3000 K) 3 h prior to sleep. RESULTS Random-effects mixed-model analysis showed no significantly greater change in fatigue on the Brief Fatigue Inventory during Treatment, but a medium effect size of improvement (p = .33, d = -0.42). There were significantly greater decreases in sleep disturbance (p = .004), insomnia symptoms (p = .036), reaction time (p = .004) and improvements in productive activity (p = .005) at end of Treatment relative to Control, with large effect sizes (d > 0.80). Changes in other outcomes were non-significant. CONCLUSIONS This pilot study provides preliminary support for in-home dynamic light therapy to address sleep-related symptoms in acquired brain injury. TRIAL REGISTRATION This trial was registered with the Australian and New Zealand Clinical Trials Registry on 13 June 2017, www.anzctr.org.au , ACTRN12617000866303.
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Affiliation(s)
- Laura J Connolly
- Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia. .,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, USA
| | - Jade M Murray
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Gershon Spitz
- Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Steven W Lockley
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, USA
| | - Jennie L Ponsford
- Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
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Ran Y, Ye L, Ding Z, Gao F, Yang S, Fang B, Liu Z, Xi J. Melatonin Protects Against Ischemic Brain Injury by Modulating PI3K/AKT Signaling Pathway via Suppression of PTEN Activity. ASN Neuro 2021; 13:17590914211022888. [PMID: 34120482 PMCID: PMC8207287 DOI: 10.1177/17590914211022888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Stroke is one of the leading causes of death and disability worldwide with limited therapeutic options. Melatonin can attenuate ischemic brain damage with improved functional outcomes. However, the cellular mechanisms of melatonin-driven neuroprotection against post-stroke neuronal death remain unknown. Here, distal middle cerebral artery occlusion (dMCAO) was performed in C57BL/6j mice to develop an ischemic stroke in vivo model. Melatonin was injected intraperitoneally immediately after ischemia, and 24 and 48 hours later. Melatonin treatment, with 5 to 20 mg/kg, elicited a dose-dependent decrease in infarct volume and concomitant increase in sensorimotor function. At the molecular level, phosphorylation of PTEN and Akt were increased, whereas PTEN activity was decreased in melatonin treated animals 72 hours after dMCAO. At the cellular level, oxygenglucose deprivation (OGD) challenge of neuronal cell line Neuro-2a (N2a) and primary neurons supported melatonin’s direct protection against neuronal cell death. Melatonin treatment reduced LDH release and neuronal apoptosis at various time points, markedly increased Akt phosphorylation in neuronal membrane, but significantly suppressed it in the cytoplasm of post-OGD neurons. Mechanistically, melatonin-induced Akt phosphorylation and neuronal survival was blocked by Wortmannin, a potent PIP3 inhibitor, exposing increased PI3K/Akt activation as a central player in melatonin-driven neuroprotection. Finally, PTEN knock-down through siRNA significantly inhibited PI3K/Akt activation and cell survival following melatonin treatment, suggesting that melatonin protection against ischemic brain damage, is at least partially, dependent on modulation of the PTEN/PI3K/Akt signaling axis.
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Affiliation(s)
- Yuanyuan Ran
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Shijingshan, China
| | - Lin Ye
- School of Materials Science and Engineering, Beijing Institute of Technology, Haidian, China
| | - Zitong Ding
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Shijingshan, China
| | - Fuhai Gao
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Shijingshan, China
| | - Shuiqing Yang
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Shijingshan, China
| | - Boyan Fang
- Department of Neurological Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Shijingshan, China
| | - Zongjian Liu
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Shijingshan, China
| | - Jianing Xi
- Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Shijingshan, China
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Nutraceuticals as Potential Targets for the Development of a Functional Beverage for Improving Sleep Quality. BEVERAGES 2021. [DOI: 10.3390/beverages7020033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Functional beverages can be a valuable component of the human diet with the ability to not only provide essential hydration but to deliver important bioactive compounds that can contribute to chronic disease treatment and prevention. One area of the functional beverage market that has seen an increase in demand in recent years are beverages that promote relaxation and sleep. Sleep is an essential biological process, with optimal sleep being defined as one of adequate duration, quality and timing. It is regulated by a number of neurotransmitters which are, in turn, regulated by dietary intake of essential bioactive compounds. This narrative review aimed to evaluate the latest evidence of the sleep promoting properties of a selection of bioactive compounds (such as L-theanine and L-tryptophan) for the development of a functional beverage to improve sleep quality; and the effectiveness of traditional sleep promoting beverages (such as milk and chamomile). Overall, the bioactive compounds identified in this review, play essential roles in the synthesis and regulation of important neurotransmitters involved in the sleep-wake cycle. There is also significant potential for their inclusion in a number of functional beverages as the main ingredient on their own or in combination. Future studies should consider dosage; interactions with the beverage matrix, medications and other nutraceuticals; bioavailability during storage and following ingestion; as well as the sensory profile of the developed beverages, among others, when determining their effectiveness in a functional beverage to improve sleep quality.
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Pilon L, Frankenmolen N, Bertens D. Treatments for sleep disturbances in individuals with acquired brain injury: A systematic review. Clin Rehabil 2021; 35:1518-1529. [PMID: 34013776 PMCID: PMC8524684 DOI: 10.1177/02692155211014827] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To systematically review the evidence on the treatments of sleep disturbances in individuals with acquired brain injury. DATA SOURCES PubMed, Embase, Web of Science, and PsycINFO were searched from inception to January 2021. REVIEW METHOD Eligibility criteria were (1) participants with mild to severe acquired brain injury from traumatic brain injury and stroke (⩾three months post-injury), (2) individuals aged 16 years and older, (3) participants with self-reported sleep disturbances, (4) controlled group studies and single case (experimental) studies, and (5) interventions aimed at treatment of sleep disturbances. Two researchers independently identified relevant studies and assessed their study quality using the revised Cochrane assessment of bias tool (RoB 2.0) and the risk-of-bias in N-of-1 trials (RoBiNT) scale. RESULTS The search yielded 655 records; 11 studies met the inclusion criteria and were included, with a total of 227 participants (207 individuals with traumatic brain injury, 20 stroke patients). Two studies included pharmacological therapy, six studies examined the effects of cognitive behavioral therapy and three studies investigated alternative interventions such as acupuncture. CONCLUSION Although there was heterogeneity in the study quality of the included studies, their outcomes suggest that cognitive behavioral therapy is recommended as treatment of choice for improving sleep in individuals with acquired brain injury, especially for patients with mild to severe traumatic brain injury. Future research should examine the effects of cognitive behavioral therapy in more high-quality randomized controlled designs.
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Affiliation(s)
- Louise Pilon
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Nikita Frankenmolen
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Dirk Bertens
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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Geng Z, Guo Z, Guo R, Ye R, Zhu W, Yan B. Ferroptosis and traumatic brain injury. Brain Res Bull 2021; 172:212-219. [PMID: 33932492 DOI: 10.1016/j.brainresbull.2021.04.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022]
Abstract
Traumatic brain injury (TBI) is a worldwide health problem contributing to significant economic burden. TBI is difficult to treat partly due to incomplete understanding of pathophysiology. Ferroptosis is a type of iron-dependent programmed cell death which has gained increasing attention due to its possible role in TBI. Current studies have demonstrated that ferroptosis is related to the pathology of TBI, and inhibition of ferroptosis may improve long term outcomes of TBI. Therefore, clarification of the exact association between ferroptosis and traumatic brain injury is necessary and may provide new targets for treatment. This review describes (1) the ferroptosis pathways following traumatic brain injury, (2) the role of ferroptosis during the chronic phase of traumatic brain injury, and (3) potential therapies targeting the ferroptosis pathways.
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Affiliation(s)
- Zhiwen Geng
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, China.
| | - Zhiliang Guo
- Department of Neurology, The Second Affiliated Hospital of Soochow University, China.
| | - Ruibing Guo
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, China.
| | - Ruidong Ye
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, China.
| | - Wusheng Zhu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, China.
| | - Bernard Yan
- Department of Neurology, Neurointervention Service, Royal Melbourne Hospital, Australia; Melbourne Brain Centre @ RMH, Department of Medicine, University of Melbourne, Parkville, VIC, 3010, Australia.
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Beloborodova NV, Chernevskaya EA, Getsina ML. Indolic Structure Metabolites as Potential Biomarkers of Non-infectious Diseases. Curr Pharm Des 2021; 27:238-249. [PMID: 33092503 DOI: 10.2174/1381612826666201022121653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/09/2020] [Indexed: 11/22/2022]
Abstract
Interest in indolic structure metabolites, including a number of products of microbial biotransformation of the aromatic amino acid tryptophan, is increasingly growing. The review prepared by a team of authors is based on in-depthscrutiny of data available in PubMed, Scopus, Cyberleninka, Clinical Trials, and Cochrane Library, eventually narrowing the search to a set of keywords such as tryptophan metabolites; plasma metabolomics profiling; metabolomics fingerprinting; gas-, liquid chromatography mass spectrometry; serotonin; melatonin; tryptamine; indoxyl sulfate; indole-3-acetic acid; indole-3-propionic acid; 5-hydroxyindole-3-acetic acid; gut microbiota and microbial metabolites. It provides a summary that outlines the pattern of changes in the level of indolic structure metabolites in a number of diseases and deals with the data from the field of human microbiota metabolites. In modern experimental studies, including the use of gnotobiological (germ-free) animals, it has been convincingly proved that the formation of tryptophan metabolites such as indole-3-acetic acid, indole-3-propionic acid, tryptamine, and indoxyl sulfate is associated with gut bacteria. Attention to some concentration changes of indolic compounds is due to the fact that pronounced deviations and a significant decrease of these metabolites in the blood were found in a number of serious cardiovascular, brain or gastrointestinal diseases. The literature-based analysis allowed the authors to conclude that a constant (normal) level of the main metabolites of the indolic structure in the human body is maintained by a few strict anaerobic bacteria from the gut of a healthy body belonging to the species of Clostridium, Bacteroides, Peptostreptococcus, Eubacteria, etc. The authors focus on several metabolites of the indolic structure that can be called clinically significant in certain diseases, such as schizophrenia, depression, atherosclerosis, colorectal cancer, etc. Determining the level of indole metabolites in the blood can be used to diagnose and monitor the effectiveness of a comprehensive treatment approach.
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Affiliation(s)
- Natalia V Beloborodova
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Petrovka 25, bild 2, Moscow, 107031, Russian Federation
| | - Ekaterina A Chernevskaya
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Petrovka 25, bild 2, Moscow, 107031, Russian Federation
| | - Maria L Getsina
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Petrovka 25, bild 2, Moscow, 107031, Russian Federation
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Bruijel J, van Heugten CM, Murray J, Grima N, Ymer L, Walters EM, Sinclair K, Stapert SZ, Vermeeren A, Ponsford JL. The bidirectional relationship between sleep and physical activity following traumatic brain injury. J Sleep Res 2021; 30:e13334. [PMID: 33719114 PMCID: PMC8519136 DOI: 10.1111/jsr.13334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Abstract
Sleep and physical activity are both modifiable behavioural factors that are associated with better health and are potentially related. Following traumatic brain injury, damage to the brain caused by an external force, sleep disturbances are common. Exploring bidirectional relationships between sleep and physical activity might provide insight into whether increasing physical activity could decrease these sleep disturbances. The current study, therefore, examined inter- and intra-individual temporal associations between sleep and daytime physical activity in 64 people with traumatic brain injury reporting sleep problems or fatigue (47 males; mean age, 40 years). Sleep and physical activity were measured using actigraphy with corroborating sleep diaries over 14 consecutive days. Multilevel models were used to examine inter- and intra-individual associations between physical activity and sleep. Inter-individual variations showed that earlier bedtimes, earlier wake-up times and lower sleep efficiency were associated with more physical activity. Intra-individual temporal variations showed no significant association of daytime physical activity with sleep duration or continuity. However, shorter sleep time and less wake after sleep onset than usual were associated with more time spent in light-intensity activity the next day. Therefore, sleep may have more of an influence on physical activity than physical activity has on sleep in people with traumatic brain injury. In conclusion, the results do not confirm a potential beneficial effect of physical activity on sleep but suggest that improving sleep quality might be relevant to support of a physically active lifestyle in people with traumatic brain injury. Further research is necessary to confirm these results.
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Affiliation(s)
- Jessica Bruijel
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Centre, Maastricht, The Netherlands
| | - Caroline M van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Centre, Maastricht, The Netherlands.,Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical center, Maastricht, The Netherlands
| | - Jade Murray
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Vic., Australia
| | - Natalie Grima
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Vic., Australia.,Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Vic., Australia
| | - Lucy Ymer
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Vic., Australia.,Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Vic., Australia
| | - Elizabeth M Walters
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Vic., Australia
| | - Kelly Sinclair
- Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Vic., Australia
| | - Sven Z Stapert
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Centre, Maastricht, The Netherlands.,Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Annemiek Vermeeren
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jennie L Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Vic., Australia.,Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Vic., Australia
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Grima NA, Rajaratnam SMW, Mansfield D, McKenzie D, Ponsford JL. Poorer sleep quality predicts melatonin response in TBI patients: findings from a randomized controlled trial. J Clin Sleep Med 2021; 17:1545-1551. [PMID: 33704046 DOI: 10.5664/jcsm.9234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES A recent clinical trial demonstrated that melatonin treatment was effective in improving self-perceived sleep quality in patients with TBI; however, it remains unclear which patients benefited from melatonin treatment. To that end, findings from the clinical trial were re-examined to identify possible predictors of treatment response. METHODS Hierarchical multiple regression was utilized to identify patient characteristics, TBI injury characteristics, and self-report measures assessing sleep, fatigue, mood, and anxiety symptomatology that may uniquely explain a change in self-reported sleep quality scores (follow-up minus baseline score) as assessed by the Pittsburgh Sleep Quality Index(PSQI). RESULTS After controlling for patient demographic and TBI injury-related variables, baseline self-report measures of sleep, fatigue, mood, and anxiety explained an additional 32% of the variance in change in PSQI scores. However, only baseline PSQI score made a unique and statistically significant contribution (β = -.56, p = .006). After controlling for patient and TBI characteristics, baseline PSQI scores further explained 27% of the variance in change in PSQI scores, R squared change = .27, F change (1, 27) = 11.79, p = .002). The standardized beta for baseline PSQI score revealed a statistically significant negative relationship with change in PSQI score (β = -.54, p = .002) revealing that higher PSQI score at baseline was associated with better sleep outcomes. CONCLUSIONS In a sample comprising predominately severe TBI and comorbid insomnia, participants who report poorer sleep quality have the most to gain from melatonin treatment irrespective of time since injury, demographics, fatigue, daytimes sleepiness, mood, and anxiety symptomology. CLINICAL TRIAL REGISTRATION The manuscript reports on a clinical trial which was prospectively registered with the Australian New Zealand Clinical Trials Registry on the 13th of July, 2011. Identifier: ACTRN12611000734965 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343083&showOriginal=true&isReview=true.
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Affiliation(s)
- Natalie A Grima
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Richmond, VIC, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton Campus, Clayton, VIC, Australia
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton Campus, Clayton, VIC, Australia
| | - Darren Mansfield
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton Campus, Clayton, VIC, Australia.,Monash Lung and Sleep, Monash Health, Clayton, VIC, Australia
| | - Dean McKenzie
- Epworth HealthCare, Richmond, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, St. Kilda, VIC, Australia
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Richmond, VIC, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton Campus, Clayton, VIC, Australia
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McCorkle TA, Barson JR, Raghupathi R. A Role for the Amygdala in Impairments of Affective Behaviors Following Mild Traumatic Brain Injury. Front Behav Neurosci 2021; 15:601275. [PMID: 33746719 PMCID: PMC7969709 DOI: 10.3389/fnbeh.2021.601275] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/29/2021] [Indexed: 11/30/2022] Open
Abstract
Mild traumatic brain injury (TBI) results in chronic affective disorders such as depression, anxiety, and fear that persist up to years following injury and significantly impair the quality of life for patients. Although a great deal of research has contributed to defining symptoms of mild TBI, there are no adequate drug therapies for brain-injured individuals. Preclinical studies have modeled these deficits in affective behaviors post-injury to understand the underlying mechanisms with a view to developing appropriate treatment strategies. These studies have also unveiled sex differences that contribute to the varying phenotypes associated with each behavior. Although clinical and preclinical studies have viewed these behavioral deficits as separate entities with unique neurobiological mechanisms, mechanistic similarities suggest that a novel approach is needed to advance research on drug therapy. This review will discuss the circuitry involved in the expression of deficits in affective behaviors following mild TBI in humans and animals and provide evidence that the manifestation of impairment in these behaviors stems from an amygdala-dependent emotional processing deficit. It will highlight mechanistic similarities between these different types of affective behaviors that can potentially advance mild TBI drug therapy by investigating treatments for the deficits in affective behaviors as one entity, requiring the same treatment.
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Affiliation(s)
- Taylor A. McCorkle
- Graduate Program in Neuroscience, Graduate School of Biomedical Sciences and Professional Studies, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Jessica R. Barson
- Graduate Program in Neuroscience, Graduate School of Biomedical Sciences and Professional Studies, Drexel University College of Medicine, Philadelphia, PA, United States
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Ramesh Raghupathi
- Graduate Program in Neuroscience, Graduate School of Biomedical Sciences and Professional Studies, Drexel University College of Medicine, Philadelphia, PA, United States
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
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43
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Lugo GJ, Beletanga M, Goldstein L, Rana M, Jonas R, Torres AR. Assessment and Treatment of Concussion in the Pediatric Population. Semin Neurol 2021; 41:132-146. [PMID: 33657625 DOI: 10.1055/s-0041-1725135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Traumatic brain injury (TBI) is common in children. The evaluation and management of children with TBI is based on the research performed in adults. There is a relative paucity of research in the literature involving children and many of the practice recommendations for this age are based on expert opinion in the absence of good research studies in both sports and non-sports-related injuries. The pediatric population is heterogeneous and the approach might be specific for infants, preschoolers, school age children, and adolescents. Children may also suffer from neurodevelopmental disabilities, making their evaluation even more challenging. Adult neurologists are often asked to see children due to increasing demands. This review will focus on specific issues related to TBI in children that might be useful to adult neurologists. Science, however, is evolving rapidly and physicians should make sure to remain up to date to offer evidence-based services to their patients.
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Affiliation(s)
- Giancarlo J Lugo
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Maria Beletanga
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Laura Goldstein
- Division of Child Psychiatry, Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
| | - Mandeep Rana
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Rinat Jonas
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Alcy R Torres
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Pediatric Brain Injury Program, Boston University School of Medicine, Boston, Massachusetts
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Chan V, Lo K. Efficacy of dietary supplements on improving sleep quality: a systematic review and meta-analysis. Postgrad Med J 2021; 98:285-293. [PMID: 33441476 DOI: 10.1136/postgradmedj-2020-139319] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/22/2020] [Accepted: 12/03/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Different dietary supplements aimed at improving sleep quality are available on the market, but there has not been a comprehensive review to evaluate the efficacy of these dietary supplements on subjective sleep quality. We aimed to summarise up-to-date research evidence and to identify the types of dietary supplement that improve subjective sleep quality. METHODS Multiple databases (Ovid Emcare, Ovid MEDLINE (R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and APA PsycInfo) were used for searching papers published until August 2020. The changes in sleep quality indices, intervention duration and sample size were extracted from every paper. To analyse the effect of dietary supplements on sleep quality, a random effects model with mean difference (MD) and 95% CI was adopted. The heterogeneity across studies was measured by I2 statistics. The quality of included studies was evaluated by Cochrane's risk of bias tool. RESULTS Thirty-one randomised controlled trials of dietary supplements were included. Subjective sleep quality was significantly improved by supplementation of amino acids (MD -1.27, 95% CI -2.35 to -0.20; I2=0%), melatonin (MD -1.21, 95% CI -2.17 to -0.24; I2=79%) and vitamin D (MD -1.63, 95% CI -3.15 to -0.10; I2=85%). Although not all studies provided adequate data for meta-analysis, we also discussed how magnesium, zinc, resveratrol and nitrate supplementation may improve sleep quality. CONCLUSIONS Amino acids, vitamin D and melatonin supplements were significantly beneficial to improve sleep quality. However, high heterogeneity and wide confidence levels were observed in vitamin D and melatonin. Further research on the effect of magnesium, zinc, resveratrol and nitrate supplementation on improving sleep quality is required.
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Affiliation(s)
- Vicky Chan
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Kenneth Lo
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Shahrokh S, Qobadighadikolaei R, Abbasinazari M, Haghazali M, Asadzadeh Aghdaei H, Abdi S, Balaii H, Khanzadeh-Moghaddam N, Zali MR. Efficacy and Safety of Melatonin as an Adjunctive Therapy on Clinical, Biochemical, and Quality of Life in Patients with Ulcerative Colitis. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2021; 20:197-205. [PMID: 34567156 PMCID: PMC8457739 DOI: 10.22037/ijpr.2020.113822.14508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Ulcerative colitis (UC) is characterized by recurring episodes of inflammation limited to the mucosal layer of the colon. The exact etiology of UC is unknown, but the role of autoimmunity and activated inflammatory cascade is quite clear. Melatonin possesses anti-inflammatory and immune-modulative properties in animal and clinical trials. The aim of the present study was to evaluate the efficacy and safety of oral melatonin as an adjudicative therapy in clinical, biochemical, and quality of life in UC patients. Thirty patients diagnosed with mild to moderate UC, were randomly allocated to either receive melatonin (3 mg/d) or the placebo group for three months. Simple clinical colitis activity index (SCCAI), fecal calprotectin (FC), C-reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR), and Sf-36 questionnaire have been used for assessment at the baseline and the end of the trial. Melatonin significantly improve SCCAI score, FC, role-emotional, energy and general health relative to placebo (p = 0.03, 0.05, 0.002, 0.032, 0.004 respectively). Regarding CRP, ESR, and the other components of SF-36 there is not any significant difference between melatonin and placebo group. Melatonin supplementation over a three-month period is effective and safe in improving clinical index, FC, and some quality of life in patients with mild to moderate UC.
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Affiliation(s)
- Shabnam Shahrokh
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roja Qobadighadikolaei
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Abbasinazari
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Haghazali
- Shaheed Rajaei Cardiovascular Medical and Research Center, Tehran, Iran
| | - Hamid Asadzadeh Aghdaei
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Abdi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hedieh Balaii
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Khanzadeh-Moghaddam
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Cheng YS, Tseng PT, Wu YC, Tu YK, Wu CK, Hsu CW, Lei WT, Li DJ, Chen TY, Stubbs B, Carvalho AF, Liang CS, Yeh TC, Chu CS, Chen YW, Lin PY, Wu MK, Sun CK. Therapeutic benefits of pharmacologic and nonpharmacologic treatments for depressive symptoms after traumatic brain injury: a systematic review and network meta-analysis. J Psychiatry Neurosci 2021; 46:E196-E207. [PMID: 33497170 PMCID: PMC7955847 DOI: 10.1503/jpn.190122] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Depression is a common morbidity after traumatic brain injury. This network meta-analysis investigated the efficacy and tolerability of pharmacologic and nonpharmacologic interventions for depression after traumatic brain injury. METHODS We extracted randomized controlled trials examining pharmacologic or nonpharmacologic interventions with placebo- or active-controlled designs from PubMed, the Cochrane Library and ScienceDirect, from inception to October 30, 2018. We based study selection and extraction of a predefined list of variables on the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, and conducted meta-analysis procedures using random effects modelling. Primary outcomes were changes in depressive symptom severity after pharmacologic or nonpharmacologic treatment; the secondary outcome was tolerability, reflected in overall patient dropout rates. RESULTS Our analysis of 27 randomized controlled trials (10 pharmacologic, total n = 483, mean age = 37.9 yr; 17 nonpharmacologic, total n = 1083, mean age = 38.0 yr) showed that methylphenidate had significantly superior efficacy compared to placebo or control (standardized mean difference -0.91, 95% confidence interval [CI] -1.49 to -0.33). Sertraline was associated with significantly lower tolerability (i.e., a higher dropout rate) compared to placebo or control (odds ratio 2.65, 95% CI 1.27 to 5.54). No nonpharmacologic treatment was more effective than the others, and we found no significant differences in tolerability (i.e., dropout rates) among the nonpharmacologic treatments. LIMITATIONS Heterogeneity in participant characteristics (e.g., comorbidities), study designs (e.g., trial duration) and psychopathology assessment tools, as well as small trial numbers for some treatment arms, could have been confounders. CONCLUSION The present network meta-analysis suggests that methylphenidate might be the best pharmacologic intervention for depressive symptoms related to traumatic brain injury. None of the nonpharmacologic interventions was associated with better improvement in depressive symptoms than the others or than control conditions. None of the pharmacologic or nonpharmacologic treatments had inferior tolerability compared to placebo or controls except for sertraline, which had significantly lower tolerability than placebo.
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Affiliation(s)
- Yu-Shian Cheng
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Ping-Tao Tseng
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Yi-Cheng Wu
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Yu-Kang Tu
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Ching-Kuan Wu
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Chih-Wei Hsu
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Wei-Te Lei
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Dian-Jeng Li
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Tien-Yu Chen
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Brendon Stubbs
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Andre F Carvalho
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Chih-Sung Liang
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Ta-Chuan Yeh
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Che-Sheng Chu
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Yen-Wen Chen
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Pao-Yen Lin
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Ming-Kung Wu
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Cheuk-Kwan Sun
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
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Sleep disorders in traumatic brain injury. ACTA ACUST UNITED AC 2020; 32:178-187. [PMID: 34218878 DOI: 10.1016/j.neucie.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 09/03/2020] [Indexed: 11/21/2022]
Abstract
The purpose of the review is to collect the most relevant current literature on the mechanisms of normal sleep and sleep disorders associated with traumatic brain injury (TBI), to discuss the most frequent conditions and the evidence on their possible treatments and future research. Sleep disorders are extremely prevalent after TBI (30-84%). Insomnia and circadian rhythm disorders are the most frequent disorders among the population that has suffered mild TBI, while hypersomnolence disorders are more frequent in populations that have suffered moderate and severe TBI. The syndrome of obstructive sleep apnea and restless leg syndrome are also very frequent in these patients; and patients exposed to multiple TBIs (war veterans) are especially susceptible to sleep disorders. The treatment of these disorders requires taking into account the particularities of these patients. In conclusion, diagnosis and treatment of sleep disorders should become part of routine clinical practice and cease to be anecdotal (as it is today) in patients with TBI. In addition, it is necessary to continue carrying out research that reveals the best therapeutic approach to these patients.
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Iyer KK, Zalesky A, Cocchi L, Barlow KM. Neural Correlates of Sleep Recovery following Melatonin Treatment for Pediatric Concussion: A Randomized Controlled Trial. J Neurotrauma 2020; 37:2647-2655. [DOI: 10.1089/neu.2020.7200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kartik K. Iyer
- Faculty of Medicine, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre and Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Luca Cocchi
- QIMR Berghofer Medical Research Institute, Clinical Brain Networks Group, Brisbane, Queensland, Australia
| | - Karen M. Barlow
- Faculty of Medicine, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Department of Neurology, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- University of Calgary, Calgary, Alberta, Canada
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Paredes I, Navarro B, Lagares A. Sleep disorders in traumatic brain injury. Neurocirugia (Astur) 2020; 32:S1130-1473(20)30124-X. [PMID: 33189564 DOI: 10.1016/j.neucir.2020.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/29/2020] [Accepted: 09/03/2020] [Indexed: 11/20/2022]
Abstract
The purpose of the review is to collect the most relevant current literature on the mechanisms of normal sleep and sleep disorders associated with traumatic brain injury (TBI), to discuss the most frequent conditions and the evidence on their possible treatments and future research. Sleep disorders are extremely prevalent after TBI (30-84%). Insomnia and circadian rhythm disorders are the most frequent disorders among the population that has suffered mild TBI, while hypersomnolence disorders are more frequent in populations that have suffered moderate and severe TBI. The syndrome of obstructive sleep apnea and restless leg syndrome are also very frequent in these patients; and patients exposed to multiple TBIs (war veterans) are especially susceptible to sleep disorders. The treatment of these disorders requires taking into account the particularities of these patients. In conclusion, diagnosis and treatment of sleep disorders should become part of routine clinical practice and cease to be anecdotal (as it is today) in patients with TBI. In addition, it is necessary to continue carrying out research that reveals the best therapeutic approach to these patients.
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Affiliation(s)
- Igor Paredes
- Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Madrid, España.
| | - Blanca Navarro
- Servicio de Neurocirugía, Neuropsicología Clínica, Hospital Universitario 12 de Octubre, Madrid, España
| | - Alfonso Lagares
- Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Madrid, España
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Barlow KM, Kirk V, Brooks B, Esser MJ, Yeates KO, Zemek R, Kirton A, Mikrogianakis A, MacMaster F, Nettel-Aguirre A, Hutchison J, Turley B, Cameron C, Hill M, Boyd R, Dewey D. Efficacy of Melatonin for Sleep Disturbance in Children with Persistent Post-Concussion Symptoms: Secondary Analysis of a Randomized Controlled Trial. J Neurotrauma 2020; 38:950-959. [PMID: 32988292 DOI: 10.1089/neu.2020.7154] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Sleep disturbances are commonly reported in children with persistent post-concussion symptoms (PPCS). Melatonin treatment is often recommended, yet supporting evidence is scarce. We aimed to evaluate the efficacy of treatment with melatonin for sleep disturbance in youth with PPCS following mild traumatic brain injury (mTBI). This article is a secondary analysis of a clinical trial of melatonin compared with placebo to treat PPCS. Youth (8-18 years of age) with PPCS and significant sleep-related problems (SRPs) at 4-6 weeks post-injury were eligible. Exclusion criteria: significant medical/psychiatric history; previous concussion/mTBI within 3 months. Treatment groups were: placebo, melatonin 3 mg, or melatonin 10 mg. Primary outcome was change in SRPs measured using the Post-Concussion Symptom Inventory (PCSI) after 2 weeks of treatment. Secondary outcomes included change in actigraphy sleep efficiency, duration, onset latency, and wake-after-sleep-onset. Behavior was measured using Behaviour Assessment for Children (2nd edition). Seventy-two participants (mean age 14.0, standard deviation [SD] = 2.6) years; 60% female) with PPCS and significant sleep disturbance were included in the secondary analysis: placebo (n = 22); melatonin 3 mg (n = 25); melatonin 10 mg (n = 25). Sixty-four participants had actigraphy data. SRPs decreased across all groups over time with a significant effect of melatonin 3 mg (3.7; 95% confidence interval [CI]: 2.1, 5.4) compared with placebo (7.4; 95% CI: 4.2, 10.6) and melatonin 10 mg (6.4; 95% CI: 3.6, 9.2). Sleep duration increased in the melatonin 3 mg (43 min; 95% CI: 6, 93) and melatonin 10 mg groups (55 min; 95% CI: 5, 104) compared with placebo. A per protocol analysis demonstrated improved sleep efficiency in the melatonin 10 mg group (p = 0.029). No serious adverse events were reported. Depressive symptoms significantly decreased with melatonin 3 mg (-4.7; 95% CI: -9.2, -.2) but not with melatonin 10 mg (-1.4, 95% CI: -5.9, 3.2) treatment compared with placebo. Changes in cognition or behavior were otherwise not significantly different between treatment groups. Short-term melatonin is a well-tolerated treatment for sleep disturbance in youth with PPCS following mTBI. In this context, it may also be associated with a reduction in depressive symptoms.
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Affiliation(s)
- Karen Maria Barlow
- Child Health Research Centre, University of Queensland Faculty of Medicine and Biomedical Sciences, South Brisbane, Queensland, Australia.,Department of Paediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Valerie Kirk
- Department of Paediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Brian Brooks
- Department of Pediatrics, Clinical Neurosciences, and Psychology, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | | | - Keith Owen Yeates
- Department of Psychology and University of Calgary, Calgary, Alberta, Canada
| | - Roger Zemek
- Clinical Research Unit, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Adam Kirton
- Department of Paediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Frank MacMaster
- Department of Psychiatry and Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Alberto Nettel-Aguirre
- Department of Paediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - James Hutchison
- Critical Care Medicine and Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brenda Turley
- Department of Pediatrics, Clinical Neurosciences, and Psychology, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Candice Cameron
- Research Pharmacy, Alberta Health Services, Calgary, Alberta, Canada
| | - Michael Hill
- Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Roslyn Boyd
- Children's Health Research Centre, University of Queensland, South Brisbane, Queensland, Australia
| | - Deborah Dewey
- Department of Paediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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