ACETYLCHOLINE AND NEURONAL ACTIVITY: I. CHOLINESTERASE PATTERNS AND ACETYLCHOLINE IN THE CEREBROSPINAL FLUIDS OF PATIENTS WITH CRANIOCEREBRAL TRAUMA

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Abstract
Cerebrospinal fluid acetylcholine and cholinesterase determinations were made on 112 neurological and neurosurgical patients. Results on 15 patients with craniocerebral trauma and six psychiatric patients treated with electric shock convulsant therapy (E.C.T.) are reported in detail. Except for epileptics the only cerebrospinal fluid assays positive for acetylcholine occurred in the traumatic and E.C.T. groups, in which acetylcholine levels were 0.2 to 100 +μgm. %. In contrast to all other patients cerebrospinal fluid cholinesterases of traumatic and E.C.T. groups showed reversals of normal fraction patterns. These consisted of reduction of specific and increase of unspecified cholinesterase fractions, together with decrease of total cholinesterase activity. Acetylcholine levels and extent of cholinesterase fraction reversals paralleled the severity of cerebral damage, judged by clinical and electroencephalographic (E.E.G.) signs. Coma or semiconsciousness and depression of E.E.G. activity were associated with presence of acetylcholine and marked reversals of cholinesterase fractions in cerebrospinal fluids. In less severe cases and during recovery, when patients were disoriented and confused and E.E.G. activity was increased, cerebrospinal fluid acetylcholine decreased and disappeared, and cholinesterase values returned toward normal. Similar cerebrospinal fluid abnormalities were seen in patients after E.C.T. Changes in cerebrospinal fluid cholinesterase fraction patterns seem to be sensitive indications of extent of cerebral injury and progress toward recovery.