Most randomised clinical trials for TBI treatments carried out to date have failed to show significant benefits.
(PRWEB UK) 29 May 2015
European Neurological Review, a peer-reviewed, open access, bi-annual neurology journal published a cutting-edge article by Johannes Thome and Dafin F Muresanu.
Abstract: Traumatic brain injury (TBI) is a significant cause of disability and death and its incidence is rising in some specific populations. TBI can result in various disabilities, cognitive problems and psychiatric disorders, depending on the location of the injury and premorbid patient conditions. Effective pharmacological and surgical treatments, however, are currently limited. Most randomised clinical trials for TBI treatments carried out to date have failed to show significant benefits. Initiatives such as the TRACK-TBI have highlighted the large variability in TBI treatment quality at different hospitals and widely differing death rates. This stimulated the establishment of the International Initiative for TBI Research (InTIBR), which aims to improve disease characterisation and patient management. The development of effective treatments for TBI and their evaluation requires an understanding of the complex neuroregenerative processes that follow an injury. In the case of haematoma in TBI, decompressive craniectomy can be a life-saving intervention but must be performed rapidly. The neurotrophic agent, Cerebrolysin®, acts by mimicking neurotrophic factors (NTFs) and by stimulating the endogenous production of NTF in brain tissue. Experimental models show that this drug increases neurogenesis following TBI but these findings need to be converted into clinical practice. The potential of Cerebrolysin in TBI was demonstrated in a large retrospective cohort trial in Romania (n=7,769 adults). Cerebrolysin significantly improved Glasgow Outcome Scores (GOS) and respiratory distress (RDS) in patients with moderate or severe TBI at 10 and 30 days compared with controls. This and other experimental treatments have potential in TBI but, in developing such therapies, the design of clinical trials should closely reflect the reality of biological processes underlying natural recovery from brain injury.
Traumatic brain injury (TBI) is a condition with many unmet needs in medicine and public health.1,2 It is a major cause of death and disability and also leads to extremely high direct and indirect costs to society.3–5 Currently the incidence of TBI among some populations such as the elderly and military personnel is increasing.6,7 TBI populations are heterogeneous in terms of mechanism of disease, baseline prognostic risk factors, clinical severity and evolution.8 This heterogeneity generates complex challenges. New pharmacological approaches together with more basic and clinical research are needed for better targeting TBI therapy for individual patients.9 Monomodal drugs have substantial limitations in TBI treatment and have little efficacy. Multimodal drugs, however, have shown promising results. A key example is the neurotrophic agent Cerebrolysin®, which has shown efficacy for the treatment of TBI in various studies.10,11 This article provides an overview of major research progress in the pathology and diagnosis of TBI and the prospects for new drug treatments that were presented and discussed at the 21st International Mondsee Medical Meeting, which was convened at Salzburg, Austria in June 2014.
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