M. Metka

Identifying target regions for vigilance improvement under hormone replacement therapy in postmenopausal syndrome patients by means of electroencephalographic tomography (LORETA)

RationaleDaytime fatigue, which at the neurophysiological level is due to vigilance decrements, is a frequent complaint in postmenopausal women.ObjectivesIn a three-arm, 2-month, parallel group-design study, vigilance-promoting effects of a novel continuous combination (=Climodien 2/3) of estradiol valerate (EV; 2 mg) and dienogest (DNG; 3 mg) were compared with the effects of both EV alone and placebo in 55 insomniac, postmenopausal syndrome patients.MethodsLow-resolution brain electromagnetic tomography (LORETA) was undertaken to identify the cerebral target regions of hormone replacement therapy.ResultsAn omnibus significance test revealed Climodien to increase activity in 882 of 2,394 voxels in the alpha-2 band, followed by 733, 706, and 664 voxels in the beta-2, beta-1, and beta-3 bands, and 509 voxels in the delta band, whereas 2 mg EV alone did not produce a significant suprathreshold activity. Current density increased predominantly in the right hemisphere, which had already been described in the literature as the center of the vigilance system. In the fast alpha range, which plays a major role in the context of vigilance, increased activity was found in the right prefrontal, temporal, and superior parietal cortices, i.e., those brain areas of the right-sided fronto-parietal neuronal network that are responsible for sustained attention. A further activity increase was seen in the anterior cingulate gyrus associated with attentional control and conflict monitoring. The right temporal lobe showed increased current density in all frequency bands.ConclusionsElectroencephalographic tomography (LORETA) identified the right-hemispheric vigilance system as the target region of Climodien.

Hormone replacement therapy and its influence on AT-III activity in climacteric women.

50-85% of women report several complaints during the climacteric period and menopause. Complaints may include flush, sleep disturbances of depressions and seriously impair the patients well-being. We were interested to determine whether estrogen in various modes of application (oral or transdermal) can alter antithrombin III activity. The menopausal status was investigated in all patients (Ez levels <30 pg/ml, FSH levels >40 mu/ml). 175 patients received conjugated estrogens at 0.625 mg (group I), 82 patients were given conjugated estrogens at 1.25 mg (group II), and 107 patients were treated by transdermal estrogen application (TTS 50 mcg) (group Ill). All replacement schemes contained additional progestin (progestin derivatives [1]. A hormone status as well as clinical antithrombin III determination were performed before therapy and 12 months after the beginning of estrogen replacement. Antithrombin III determination was performed with the AT-III color test developed by Mannheim-Boehringer [2]. The statistical differences between the investigated parameters werde determined by way of the t-test of paired random samples. A decrease of antithrombin III activity during treatment is an indication of a shift of hemostasis towards coagulation.