Effects of melatonin in the treatment of asthenia in aneurysmal subarachnoid hemorrhage

Background and objectives Survivors of aneurysmal subarachnoid hemorrhage (aSAH) commonly experience sleep disorders resulting in asthenia. The objective of this prospective study was to determine, in a cohort of patients with treated ruptured intracranial aneurysm (IA), the proportion of asthenia at 2 months, in a cohort of patients treated with melatonin and in a control cohort. Patients and methods Twenty consecutive patients admitted for the treatment of ruptured IA and able to answer a standardized questionnaire were included in the study. After evaluation for fatigue at discharge, we divided our population into 2 cohorts of 10 patients: the first cohort was treated with melatonin for a period of 2 months; the second cohort had no specific treatment for fatigue. The primary endpoint was the proportion of asthenia at 2 months in both groups. Confounding factors, such as depression, autonomy and apathy were evaluated at the same time. Results At discharge, there was no significant difference observed between both groups in terms of mean age and initial clinical status (WFNS, Rankin Scale and Fatigue Severity Scale). At 2 months, the mean FSS score in the control group was of 4.7 ± 1.0 versus 3.8 ± 0.9 in the melatonin group ( P = 0.03). The mean MADRS score in the control group was of 1.1 ± 1.45 versus 2.7 ± 2.5 in the melatonin group ( P = 0.10). The mean LARS score in the control group was of –32.5 ± 1.7 versus –31.7 ± 1.9 in the melatonin group ( P = 0.24). Discussion In a prospective evaluation of post-aSAH fatigue, we suggest that melatonin could decrease fatigue. There is no significant impact on depression and apathy. Further studies would be necessary to improve our comprehension of fatigue physiopathology in a context of aSAH.