Efficacy of DL-3 n-butylphthalide on psychiatric,behavioural and cognitive functions in delayed encephalopathy after acute carbon monoxide poisoning

Abstract

Background The main hazards of carbon monoxide (CO) poisoning are its serious clinical effects,high incidence and mortality of toxicity.Acute brain injury and delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) are the most common neurological complications.CO poisoning can cause neurological,psychiatric,behavioural and cognitive disorders,including cortical blindness,parkinsonism,amnesia,personality changes,dementia,and mental disorders such as anxiety and depression.This study was performed to assess the efficacy of DL-3 n-butylphthalide (NBP) and dexamethasone (DXM) and hyperbaric oxygen (HBO) on psychiatric,behavioural and cognitive functions in DEACMP.Patients and methods A total of 179 patients with DEACMP were recruited and assigned to the combined-therapy group(receiving NBP and DXM 5 mg/day plus HBO therapy) or the control group (HBO therapy as monotherapy).The behavioural and cognitive functions in patients were evaluated by the Mini-Mental State Examination (MMSE),the Montreal cognitive assessment (MoCA) scale and the Barthel index of activities of daily living (ADL) after the treatment at 1 month,3 months,and 1 year respectively.The psychiatric changes in patients were evaluated by the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) after the treatment at 3 months and 1 year respectively.Results At 1 month,3 months and 1 year after the treatment,the MMSE,MoCA and ADL scores were all significantly higher in the combined therapy group than those in the control group.At 3 months and 1 year after the treatment,the HAMA and HAMD scores were all significantly lower in the combined therapy group than those in the control group.There were no significant alterations in blood glucose,blood lipids,or liver or kidney function during the whole treatment session.Some patients experienced loss of appetite,mild headache and minor skin irritations.However,these patients recovered by themselves and needed no additional medications or special treatment. Conclusion These results indicated that NBP and DXM combined with HBO for the treatment of DEACMP can significantly improve the psychiatric,behavioural and cognitive functions of patients and is very safe.