Presence of endogenous benzodiazepine-like compound in patients with anoxic encephalopathy.
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Benzodiazepines exert a neuroinhibitory effect by enhancing γ-aminobutyric acid (GABA)-mediated neurotransmission in the central nervous system. We attempted to measure endogenous benzodiazepine activity in the sera of 6 patients with anoxic encephalopathy who had been resuscitated after cardiopulmonary arrest following asphyxia, drowning, hemorrhagic shock, shock at anesthesia or arrhythmias in acute myocardial infarction. Consciousness levels, according to the Glasgow coma scale (GCS), were 3 in 3 patients, 6 in 2 and 1 in 1, none of whom had taken any synthetic benzodiazepines. To confirm the presence of the endogenous benzodiazepine-like compound, the effects of the benzodiazepine antagonist flumazenil were studied while monitoring the consciousness level, electroencephalogram (EEG) and electrooculogram (EOG). Benzodiazepine receptor assay was applied to measure serum benzodiazepine-receptor binding activity. Consciousness level, EEG and EOG were evaluated continuously for 20 minutes after intravenous bolus injection of 0.5mg of flumazenil. In 4 of 6 patients, serum benzodiazepine-receptor binding activities were detected and ranged from 80 to 650ng/ml as the diazepam equivalent concentration. In 3 patients, the administration of flumazenil induced transient improvements in the consciousness level, from 1 to 4, in the eye opening score as assessed by the GCS. The degree of anoxic encephalopathy on EEG improved from stage III-b to stage III-a, from V-a to III-b, and from V-a to IV-a in 3 of 6 patients and electromyographic artifacts were recorded on EEG in 3 patients after the administration of flumazenil. EOG showed slow eye movements before the administration of flumazenil and changed to slow eye movements overlapped by rapid eye movements after administration of the drug to 2 patients. The clinical and electrophysiological effects occurred in less than 1 minute and lasted for about 15 minutes after drug administration. These findings suggest that an endogenous benzodiazepine-like compound may be induced and may contribute to consciousness disturbance in patients with anoxic encephalopathy.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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