Early endocrine alterations reflect prolonged stress and relate to 1-year functional outcome in patients with severe brain injury.

OBJECTIVE: Severe brain injury may increase the risk of developing acute and chronic hypopituitarism. Pituitary hormone alterations developed in the early recovery phase after brain injury may have implications for long-term functional recovery. The objective of the present study was to assess the pattern and prevalence of pituitary hormone alterations 3 months after a severe brain injury with relation to functional outcome at a 1-year follow-up. DESIGN: Prospective study at a tertiary university referral centre. METHODS: A total of 163 patients admitted to neurorehabilitation after severe traumatic brain injury (TBI, n=111) or non-TBI (n=52) were included. The main outcome measures were endocrine alterations 3.3 months (median) after the brain injury and their relationship to the functioning and ability of the patients at a 1-year follow-up, as measured by the Functional Independence Measure and the Glasgow Outcome Scale-Extended. RESULTS: Three months after the injury, elevated stress hormones (i.e. 30 min stimulated cortisol, prolactin and/or IGF1) and/or suppressed gonadal or thyroid hormones were recorded in 68 and 32% of the patients respectively. At 1 year after the injury, lower functioning level (Functional Independence Measure) and lower capability of performing normal life activities (Glasgow Outcome Scale-Extended) were related to both the elevated stress hormones (P≤0.01) and the reduced gonadal and/or thyroid hormones (P≤0.01) measured at 3 months. CONCLUSION: The present study suggests that brain injury-related endocrine alterations that mimic secondary hypogonadism and hypothyroidism and that occur with elevated stress hormones most probably reflect a prolonged stress response 2-5 months after severe brain injury, rather than pituitary insufficiency per se. These endocrine alterations thus seem to reflect a more severe disease state and relate to 1-year functional outcome.

Spina bifida and sexuality.

OBJECTIVE: To evaluate sexual function amongst adult individuals with spina bifida and to register their subjective satisfaction with their sexual life and relationships. SETTING: Department for Spinal Cord Injuries, East Denmark. STUDY DESIGN AND METHODS: Cohort study. Medical record information, neurological examination, personal interview, Functional Independence Measure (FIMTM), Medical Outcome Study Short Form 36 (SF-36) on quality of life, and questions on sexual function and related topics. Study cohort: Fifty-three participants (27 women, 26 men) with spina bifida (mean age 27.1, range 18-35) years. Response rate 74%. RESULTS: Fifty-one percent of subjects regarded their sexual life as a failure or dysfunctional. However, 45% reported being satisfied with their sexual life. Participants with partners were more satisfied with their sexual life than those without partners. Faecal, but not urinary, incontinence was associated with poorer sexual function and less satisfaction. Forty-nine percent of subjects indicated that the sexual education they received at puberty was useful; however, 32% lacked knowledge about their sexual functioning with regard to their disability. CONCLUSION: There is a need for further sexual education and counselling for adults with spina bifida in order to improve their sexuality and quality of life.

[Subacute intensive rehabilitation after severe traumatic brain injury. Follow-up 6 months after discharge]. / Tidlig intensiv rehabilitering efter meget svaer traumatisk hjerneskade. Opfølgning seks måneder efter udskrivelsen.

INTRODUCTION: In September 2000 the Brain Injury Unit at Hvidovre Hospital was established, offering subacute intensive rehabilitation to patients with severe traumatic brain injury. Uptake area: Eastern part of Denmark, the Faroe Islands and Greenland. Outcome 6 months after discharge is presented for patients from the first 2 years, focusing on disability and social factors. MATERIALS AND METHODS: Patients were selected on the basis of the Glasgow Coma Scale after end of sedation to ensure that the most severely-injured were included in the study. Rehabilitation was initiated immediately regardless of the level of consciousness. Patients were assessed using established rating-scales. Local social authorities were involved at discharge. RESULTS: Of 77 consecutive patients, 5 died before follow-up and 6 patients were not seen at follow up. 79% of the remaining group had post-traumatic amnesia lasting more than 4 weeks. Nonetheless, 4 out of 5 were able to walk independently, 79% were living at home under normal conditions and 76% were independent on a personal level. A majority suffered from cognitive dysfunctions, which was often the major remaining disability. 20% had resumed normal work or education. CONCLUSION: The centralisation of rehabilitation in Denmark after very severe brain damage made it possible to conduct a structured plan for treatment and assessment during subacute rehabilitation and 6 months after discharge of patients with very severe traumatic brain injury. This has demonstrated that rehabilitation of even the most severely brain-damaged patients can be valuable.