Identifying target regions for vigilance improvement under hormone replacement therapy in postmenopausal syndrome patients by means of electroencephalographic tomography (LORETA).
BACKGROUND
Daytime fatigue, which at the neurophysiological level is due to vigilance decrements, is a frequent complaint in postmenopausal women.


OBJECTIVE
In 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.


METHODS
Low-resolution brain electromagnetic tomography (LORETA) was undertaken to identify the cerebral target regions of hormone replacement therapy.


RESULTS
An 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.


CONCLUSIONS
Electroencephalographic tomography (LORETA) identified the right-hemispheric vigilance system as the target region of Climodien.
Saletu
B
B
Department of Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. bernd.saletu@meduniwien.ac.at
Anderer
P
P
Saletu-Zyhlarz
G M
GM
Gruber
D
D
Metka
M
M
Huber
J
J
D001143:Arousal / Q000187:drug effects* / Q000502:physiology; D001931:Brain Mapping / Q000295:instrumentation / Q000379:methods*; D003627:Data Interpretation, Statistical; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D004569:Electroencephalography / Q000187:drug effects / Q000379:methods* / Q000639:trends; D004958:Estradiol / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000493:pharmacokinetics / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009277:Nandrolone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000493:pharmacokinetics / Q000627:therapeutic use; D018579:Patient Selection; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D013607:Tablets
D004338:Drug Combinations; D013607:Tablets; C454300:estradiol valerate-dienogest; D004958:Estradiol; D009277:Nandrolone