β-Endorphin in cerebrospinal fluid and serum after severe head injury

R. S. Zimmerman, R. L. Hayes, D. L. Morris, Bruce G Lyeth, W. L. Dewey, H. F. Young

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Endogenous opioids have been implicated as a cause of secondary damage after neural injury. The basis for this statement is primarily indirect evidence from studies that demonstrate neurological or physiological improvement when opiate antagonists are given. This study directly evaluates the level of the endogenous opioid β-endorphin in 15 patients with severe head injury. Levels of immunoreactive β-endorphin (ir-βE) from ventricular cerebrospinal fluid (vCSF) and serum were determined less than 24 hours after trauma. No significant correlation was found with the degree of initial injury, age, sex, or either 6- or 12-month outcome. Levels of Ir-βE from vCSF were significantly lower in patients who had received intravenous administration of morphine sulfate (48.4 ± 5.8 versus 85.9 ± 10.1 pg/ml, P = 0.008). No correlation was found between vCSF levels of ir-βE and elapsed time after injury. Although vCSF and serum ir-βE were correlated (r = 0.532, P = 0.050), the latter exhibited a different profile; the mean level of serum ir-βE was not significantly different in those patients who received morphine, and serum ir-βE had a significant negative correlation with time after injury (r = -0.587, P = 0.03). These results do not support a relationship between acute levels of vCSF or serum ir-βE and the degree of neurological injury or outcome after severe head trauma. This article, therefore, is a contribution to the body of literature in which the purported detrimental effect of β-endorphin was not demonstrated. The data do suggest a distinction between a 'central' (CSF) and 'peripheral' (serum) pool of β-endorphin, and possible feedback regulation between the exogenous opiate morphine and this central pool. This appears to be a rapidly governing mechanism that responds within hours.

Original languageEnglish (US)
Pages (from-to)764-770
Number of pages7
JournalNeurosurgery
Volume26
Issue number5
StatePublished - 1990
Externally publishedYes

Keywords

  • cerebrospinal fluid
  • coma
  • endorphin
  • head injury
  • opioids

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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    Zimmerman, R. S., Hayes, R. L., Morris, D. L., Lyeth, B. G., Dewey, W. L., & Young, H. F. (1990). β-Endorphin in cerebrospinal fluid and serum after severe head injury. Neurosurgery, 26(5), 764-770.