Efficacy of Thyrotropin-Releasing Hormone Analog for Protracted Disturbance of Consciousness due to Aneurysmal Subarachnoid Hemorrhage

• Published in: Journal of stroke and cerebrovascular diseases 2019-04, Vol.28 (4), p.988-993
• Main Authors: Shibata, Ami, Matano, Fumihiro, Fujiki, Yu, Mizunari, Takayuki, Murai, Yasuo, Yokota, Hiroyuki, Morita, Akio
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aneurysm; Consciousness - drug effects; Consciousness Disorders - diagnosis; Consciousness Disorders - drug therapy; Consciousness Disorders - etiology; Consciousness Disorders - physiopathology; Female; Humans; Male; Middle Aged; Prolonged disturbance of consciousness; protirelin tartrate hydrate; Recovery of Function; Retrospective Studies; subarachnoid hemorrhage; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - diagnosis; Subarachnoid Hemorrhage - drug therapy; Subarachnoid Hemorrhage - physiopathology; Thyrotropin-Releasing Hormone - analogs & derivatives; Thyrotropin-Releasing Hormone - therapeutic use; thyrotropin-releasing hormone analog; Time Factors; Treatment Outcome
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.036

Objective: The efficacy of thyrotropin-releasing hormone tartrate (TRH-T) for treating prolonged disturbance of consciousness due to aneurysmal subarachnoid hemorrhage (SAH) remains unclear. The purpose of the present study was to determine whether TRH-T was really effective, and what was the recovery factor when it was valid. This was a retrospective study of a single facility. Methods: We treated 208 patients with aneurysmal SAH at our hospital between 2011 and 2017. Among them, we investigated 97 cases in which TRH-T was administered to prolonged disturbance of consciousness. Thirty one patients with Hasegawa dementia rating scale-revised (HDS-R) score less than 20 were included. Patients’ HDS-R scores were evaluated 7 days after clipping the aneurysm and 2 days after completing a course of TRH-T treatment. HDS-R score increases of greater than or over equal to 8 and less than 8 were defined as good and poor outcomes, respectively. Outcomes were compared to 11 patients who did not receive TRH-T treatment. Results: Average initial and post-treatment HDS-R scores were 9 ± 6.6 and 19 ± 9.5, respectively. The good outcome group included 19 patients. Statistically significant differences in HDS-R score changes were observed between the group with initial HDS-R scores of 0-4 and the other groups. Poor outcomes were significantly correlated with age of greater than 60 years and initial HDS-R scores less than oroverequal to 4 points. The improvement in HDS-R score was significantly greater in the TRH-T administration group than the control group. Conclusions: TRH-T was effective for treating prolonged disturbance of consciousness due to aneurysmal SAH, especially in young patients with HDS-R scores between 5 and 20.