Significance of circadian rhythms in severely brain-injured patients: A clue to consciousness?

Abstract:

OBJECTIVE:To investigate the relationship between the presence of a circadian body temperature rhythm and behaviorally assessed consciousness levels in patients with disorders of consciousness (DOC; i.e., vegetative state/unresponsive wakefulness syndrome or minimally conscious state). METHODS:In a cross-sectional study, we investigated the presence of circadian temperature rhythms across 6 to 7 days using external skin temperature sensors in 18 patients with DOC. Beyond this, we examined the relationship between behaviorally assessed consciousness levels and circadian rhythmicity. RESULTS:Analyses with Lomb-Scargle periodograms revealed significant circadian rhythmicity in all patients (range 23.5-26.3 hours). We found that especially scores on the arousal subscale of the Coma Recovery Scale-Revised were closely linked to the integrity of circadian variations in body temperature. Finally, we piloted whether bright light stimulation could boost circadian rhythmicity and found positive evidence in 2 out of 8 patients. CONCLUSION:The study provides evidence for an association between circadian body temperature rhythms and arousal as a necessary precondition for consciousness. Our findings also make a case for circadian rhythms as a target for treatment as well as the application of diagnostic and therapeutic means at times when cognitive performance is expected to peak.

journal_name

Neurology

journal_title

Neurology

authors

Blume C,Lechinger J,Santhi N,del Giudice R,Gnjezda MT,Pichler G,Scarpatetti M,Donis J,Michitsch G,Schabus M

doi

10.1212/WNL.0000000000003942

subject

Has Abstract

pub_date

2017-05-16 00:00:00

pages

1933-1941

issue

20

eissn

0028-3878

issn

1526-632X

pii

WNL.0000000000003942

journal_volume

88

pub_type

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