New Treatments for TBI
Experimental Treatment for Frontal Lobe Injuries
A frontal lobe is frequently involved in a traumatic brain injury (TBI).
When the front of the head is struck, the frontal lobes will hit the inside
of the skull. The impact can result in injury because the brain is soft
(about the consistency of toothpaste). And even when the back of the head
is struck, the brain may bounce off the back of the skull, ricochet forward
and strike the front of the skull, injuring both the back and front of the
brain.
The frontal lobes are responsible for “higher” brain functions,
such as planning, decision making, and judgment (which are called “executive
functions”). When the frontal lobes are injured, an individual may
be indecisive or apathetic and have trouble initiating activity. The frontal
lobes are also responsible for regulating, checking, and inhibiting emotions
and actions. As a result, some TBI survivors with frontal lobe damage are
impulsive, moody, agitated, easily irritable, explosive, or make poor decisions.
These survivors are quite vulnerable to becoming substance abusers.
People with Attention Deficit and Hyperactivity Disorder (ADHD) experience
symptoms similar to symptoms experienced by some TBI survivors with frontal
lobe damage – difficulty focusing and concentrating, impulsiveness,
and poor decision making. One form of treatment for ADHD is a class of medications
that includes Ritalin. These drugs stimulate the brain. While giving a stimulant
to someone who is hyperactive and impulsive might seem like pouring gasoline
on a fire, it is believed that the drugs stimulate the frontal lobes and
increase their ability to regulate and control impulsive and inappropriate
behavior while enhancing the person’s planning and decision making.
Because some of the characteristics of ADHD are similar to the symptoms
of some TBI survivors with frontal lobe damage, studies have been performed
to determine if medications used to treat ADHD can be helpful in the treatment
of TBI. These studies have produced some evidence that Ritalin is helpful
with some TBI survivors in improving concentration and reducing impulsivity.
A study is currently underway at the University of Washington, one of the
model centers in the U.S. for treatment of traumatic brain injuries, to
determine if Ritalin improves short term memory (also called working memory)
in survivors who have memory impairment.
Progesterone for TBI
A new medical study shows progesterone, a hormone associated with pregnancy and sex drive is an effective treatment for traumatic brain injuries.
The study, performed at Grady Memorial Hospital in Atlanta, was published earlier in the Annals of Emergency Medicine. Doctors tested the treatment on 100 brain injury patients. Half of them received progesterone for a 3-day period and the others received a placebo. They found that patients who received the hormone retained more neural functioning and had higher survival rates from moderate brain injuries than those given the placebo.
This could be a landmark breakthrough for the 1.4 million Americans who suffer a traumatic brain injury each year. Of those, 50,000 die and many more are left with permanent damage including memory loss, concentration problems, and difficulty performing daily tasks.
Brain injuries are common but have limited treatment options adding to the importance to the discovery.
A New Hope
For years scientists speculated that progesterone may be a possible treatment option for brain injuries. In animal studies, the hormone was able to reduce swelling and diminish nerve cell loss.
The next phase of the study is a multiple center clinical trial on larger numbers of patients. Doctors are optimistic that those studies will prove the effectiveness of the treatment and that progesterone may be a viable option.
Experimental Transplantation Surgery on TBI Patients
Experiments have been performed in China on TBI patients in which brain cells were transplanted into the area of the injured brain. All of the patients had “open” head injuries; that is, the skull was fractured and part of the brain was bulging outside of the skull. Brain cells were removed from each patient during surgery to repair the brain and skull. These cells were then placed in a growth medium where they multiplied until there were approximately five million to 15 million cells.
Because our bodies’ immune systems recognize and attack anything that is foreign to the body, organs or cells that are transplanted from another body are in danger of being “rejected” by the person receiving the transplant. When cells from the patient’s own brain are used to grow additional cells, the new cells will be recognized as belonging to the patient when they are transplanted and won’t be rejected by the patient#8217;s immune system.
The cells that are used to grow new cells are known as stem cells. When stem cells reproduce, they can produce more than one kind of cell. For example, a stem cell in the brain can potentially produce both neurons (the nerve cells that relay information in the brain and spinal cord) and other types of brain cells that support and protect neurons.
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The process of growing millions of new brain cells in a laboratory can take one to two months. At that point the patient has a second surgery in which the new cells are surgically placed in the injured area of the brain.
