Rhythms of serum melatonin in patients with spinal lesions at the cervical, thoracic or lumbar region.

The neural pathway essential for the diurnal rhythm of serum melatonin was studied in humans. Blood samples from 17 patients with chronic lesions of cervical (n = 8), low thoracic or lumbar (n = 9) spinal cord were collected at 0200, 0400, 1000 and 1400 h of their normal light-dark cycle. Blood samples were also collected from eight control subjects at 0200 and 1400 h. No special treatment of food, drug or photoperiod was implemented. Serum melatonin was extracted by dichloromethane and determined by radioimmunoassay. In patients with cervical spinal lesions (C3-C7), it was found that serum melatonin levels were low and no diurnal rhythm was observed. Conversely, diurnal rhythm of circulating melatonin with significantly higher levels (P less than 0.01) in the dark period were observed in individuals with injuries at the low thoracic or lumbar regions (T9-L2). In the second experiment, blood samples from two other patients were collected for three consecutive days during acute period of spinal injuries (cervical or upper thoracic region) and serum melatonin concentrations were determined. Again, there were low levels of serum melatonin with no observable diurnal rhythm in the patient with cervical lesion (C4-5). However, diurnal rhythms were maintained with high levels in the dark period in the patient with upper thoracic spinal (T2-3) transection. Our data suggest that the cervical region of the spinal cord is part of the neural pathway essential for the diurnal rhythm of pineal melatonin secretion in human beings.