In addition to staying at the forefront of legal developments in the field of personal injury law and traumatic brain injury (TBI) cases, head injury lawyers in the Blackman Legal Group also stay abreast of the latest brain injury research, to better serve our clients on the road to a medical as well as legal recovery.
There was a time when nerve damage, spinal injury, and brain injury were thought to be permanent and irreversible. However, research has revealed that remarkable strides can be made through surgery, medication, and other treatments and therapies to restore function that was once thought lost.
The field of research is broad and in constant flux. Here is a look at the latest research.
RECENT RESEARCH ON TRAUMATIC BRAIN INJURY TREATMENTS
1. THE ADDITION OF A BRAIN TISSUE OXYGEN TENSION MONITOR IMPROVES THE OUTCOME FOR TRAUMATIC BRAIN INJURY PATIENTS
Previous research has suggested that an Intracranial Pressure monitor (ICP), a machine that estimates Cerebral Perfusion Pressure (CPP), is necessary for the care of those who have suffered from Traumatic brain injury. However even with the careful monitoring of ICP and CPP, cerebral ischemia may still occur. The authors of this article decided to determine whether the addition of brain tissue oxygen tension (PO2) monitor improved the outcome of traumatic brain injury patients.
This study involved patients with severe traumatic brain injuries, who scored less than an 8 on the Glasgow Coma Scale (GCS), and were admitted to a Level 1 trauma center were examined as part of a prospective observational database. Patients were placed in one of the two therapy groups, one group monitored PO2, ICP and CPP, while the second group only monitored ICP and CPP levels. The goal was to keep ICP levels at less than 20 mm Hg, CPP greater than 60 mm Hg, and PO2 levels greater than 25 mm Hg. There were Twenty-five patients with an average age of 44 +/- 14 years, in the therapy group using only the ICP monitor, which measures ICP and CPP. There were Twenty-eight patients with an average age of 38 years +/- 18 years, using the PO2 monitor to measure all ICP, CPP and PO2 levels.
The mortality rate of patients measuring only ICP and CPP was 44% while the mortality rate of patients measuring PO2, ICP and CPP was reduced to only 25%. In conclusion, the use of both PO2 and ICP monitors with PO2 directed therapy is correlated with a lower mortality rate following severe traumatic brain injury.
2. TREATMENT WITH MODERATE HYPOTHERMIA FOR 24 HOURS IN PATIENTS WITH SEVERE TRAUMATIC BRAIN INJURY AND COMA SCORES OF 5 TO 7 HASTENED NEUROLOGIC RECOVERY AND COULD POSSIBLY IMPROVE THE OUTCOME
Previous research has determined that the occurrence of traumatic brain injury initiates numerous metabolic processes that exacerbate the traumatic brain injury. There is evidence that hypothermia may reduce some of these harmful metabolic responses.
In a randomized controlled trial, they compared the effects of moderate hypothermia and normothermia in 82 patients with severe closed head injuries, they scored between a 3 and a 7 on the Glasgow Coma Scale. The patients that were assigned to the hypothermia group were cooled to a body temperature of 33 degrees C (91.4 degrees F) for an average for 10 hours after the traumatic brain injury has occurred, and kept at a temperature between 32 and 33 degrees Celsius for 24 hours. Then they are re-warmed to normal body temperature. A medical specialist in physical medicine and rehabilitation, who was not aware of the treatment assignments of the patients, evaluated the patients at 3, 6. and 12 months later using the Glasgow Outcome Scale.
They found that at 12 months 62% of the patients in the hypothermia group and 38% of the patients in the normothermia group had good outcomes which included moderate, mild or no disabilities at all. They found that hypothermia did not improve the outcomes of patients who had Glasgow Coma scores of 3 or 4, but patients with scores between 5 and 7 hypothermia was associated with significantly improved outcomes at 3 and 6 months, but not at 12 months. In conclusion, treatment with moderate hypothermia for 24 hours in patients with severe traumatic brain injury and coma scores of 5 to 7 hastened neurologic recovery and could possibly improve the outcome.
3. MAGNESIUM SALTS, CYCLOSPORINE A, SUBSTANCE P ANTAGONIST, OESTROGEN AND PROGESTERONE TREATMENTS ARE REVIEWED IN THIS SUMMARY OF PRIOR STUDIES
Previous studies have demonstrated that magnesium saltsadministered to the patient after the brain trauma has occurred enter the brain intracellular space and reduce the brain lesion volume. Magnesium salts are currently on clinical trial in traumatic brain injury.
Cyclosoprorine A is a chemical that has been found to inhibit the opening of the mitochondrial permeability transition pore. Administration of Cyclosporine A after traumatic brain injury has occurred has shown to reduce axonal injury and decrease the brain lesion volume.
Recent evidence has shown that substance P antagonists may decrease brain lesion volume and improve neurological outcome after ischemia and traumatic brain injury. Substance P antagonists have been shown to reduce neurogenic inflammation, oedema formation, and are clinically being trialed as antidepressants and antinociceptive agents. This all indicates that there is further investigation needed for the therapeutic use of this substance P agent after traumatic brain injury.
Studies have suggested that the hormones estrogen and progesterone are protective agents in traumatic brain injury but future studies are needed to determine the mechanisms associated with this protection and any potential for clinical application.
4. PROGESTERONE TREATMENT IN SEVERE ACUTE TRAUMATIC BRAIN INJURY PATIENTS SHOWN TO IMPROVE OUTCOME DURING FIRST 6 MONTHS
The goal of the present clinical study was to assess the long-term efficacy of progesterone on the improvement in neurologic outcome of patients with acute severe traumatic brain injury.
In this study there were 159 patients who arrived at the Neurotrauma Center of their teaching hospital within 8 hours of their traumatic brain injury with a Glasgow Coma Score of equal to or less than 8. The patients were randomized to receive either progesterone or placebo, 82 received progesterone and 77 received placebo. At 3 and 6 months after brain injury the patients were evaluated using the Glasgow Outcome Scale and a modified Functional Independence Measure Score. Based on the Glasgow Outcome Scale, patients who were given progesterone exhibited more favorable outcomes than those given the placebo. Additionally the modified Functional Measure scores in the progesterone group were higher than the patients in the placebo group at both the 3 and 6 month follow up. The mortality rate of the patients in the progesterone group was significantly lower than that of the placebo group at 6 months. Also the average intracranial pressure values at 72 hours and 7 days post injury were lower for the progesterone group.
In conclusion, their data suggests that acute severe traumatic brain injury with the administration of the progesterone have improved neurologic outcomes for up to 6 months. The results from this study provide important information for large multicenter clinical trials on progesterone as a promising neuroprotective drug.
If you have suffered a traumatic brain injury, you want access to the best facilities and the most promising treatments available to improve your condition. Contact your BIA state office, or see the Traumatic Brain Injury Resource Directory for resources in your area. If you need legal assistance obtaining compensation for your injuries, contact the Blackman Legal Group today to speak with one of our attorneys.
- Cerebral Perfusion Pressure (CPP): the net pressure gradient causing blood flow to the brain (brain perfusion). It is necessary to maintain a narrow limit of blood flow to the brain because too much blood flow can lead to Intracranial Pressure, which is very dangerous, and too little can cause brain tissue to have insufficient blood flow
- Cerebral Ischemia: inadequate blood flow to the brain in order to meet metabolic demand in the brain
- Brain Tissue Oxygen Tension (PO2): oxygen pressure in the blood of brain tissue
- Glasgow Coma Scale: A scale for measuring level of consciousness, especially after a head injury. Scoring is determined by three factors: amount of eye opening, verbal responsiveness, and motor responsiveness
- Hypothermia: Abnormally low body temperature
- Normothermia: a condition of normal body temperature
- Magnesium Salts: is a dietary supplement used to prevent/treat low levels of magnesium in the body
- Intracellular space: within a cell
- Mitochondrial permeability transition pore (MPTP): is a protein pore that is formed in the membranes of mitochondria under certain pathological conditions such as traumatic brain injury or stroke
- Axonal injury: injury to the process of the nerve fiber that generally conducts impulses away from the body of the nerve cell in the brain