Traumatic brain injury (TBI) occurs when a sudden trauma causes damage to the brain. The two main causes of TBI are falls and vehicular accidents. Falls are the leading cause of TBI and account for around 35% of all incidences. Vehicular accidents, including those involving motor vehicles, bicycles and other modes of transport, make up another 20% of TBIs. Other common causes include assaults, blast injuries from explosions, and sports-related injuries.
The primary mechanism by which external forces cause damage to the brain is rapid acceleration and deceleration of the head. This can occur due to impact or blast forces. During impact, the brain may collide with the inside of the skull or bounce back and forth in a swinging motion. This can injure brain tissue directly and cause bruising, bleeding and shearing of nerve fibers. Brain Injury Therapeutics are caused by the shock waves generated by explosions. While the shock waves travel through the brain and body tissues at supersonic speeds, creating pressure changes and tissue displacements that damage cells and blood vessels.
TBI can be classified as open or closed injuries depending on whether the skull is fractured or not. In open TBI, also known as penetrating TBI, the skull is fractured and external objects are able to directly contact the brain tissue. Closed TBI occurs when the skull remains intact despite brain damage, and the trauma is not caused by a penetrating object. Both types of injuries can vary in severity from mild to severe based on factors like the extent of damage, loss of consciousness, post-traumatic amnesia duration, and Glasgow Coma Scale scoring.
Acute and Chronic Effects of TBI
TBI often results in a combination of short and long-term effects on neurological and cognitive functioning. Some immediate effects occurring within seconds to days of injury include bruising and swelling of brain tissues (contusions), bleeding between brain layers or ventricles (subdural or epidural hematomas), shearing of axons that disrupt communication between neurons, and chemical changes in the brain due to neuronal and glial cell damage.
If untreated, these acute effects can progress and cause increased pressure within the skull (intracranial hypertension), issues with brain oxygen and blood flow (ischemia), seizures, infections, blood clots, and hydrocephalus – a buildup of cerebrospinal fluid in the brain’s ventricles that requires shunting. Longer-term effects persisting for months to years may include motor deficits, sensory impairments, cognitive changes, mood and behavioral alterations, and post-traumatic epilepsy in severe cases. Cognitive problems can impact executive functions, memory, attention, information processing speed and language abilities.
TBI Therapies – Medical and Rehabilitation Approaches
Current therapeutic approaches for TBI are primarily aimed at managing acute symptoms and supporting recovery. Emergency medical care focuses on stabilizing vital functions, reducing swelling and pressure through drugs/surgery, treating associated injuries, and preventing complications. Life-saving measures for severe injuries include intubation, ventilator support, surgery to repair skull fractures or drain hematomas, and monitoring for issues like hypoxia and seizures.
Rehabilitation therapies play a key role, especially after the subacute and chronic periods. Occupational, physical and speech/language therapies aims to regain lost motor, sensory and communication skills through repetitive practice of tasks. Cognitive rehabilitation helps improve attention, memory, problem-solving and social skills. Psychological counseling addresses mood disorders, aggression issues and facilitates community re-integration. Vocational programs prepare patients to return to work or studies.
Assistive devices and lifestyle modifications also aid independence. Splints, walkers and adaptive equipment supports mobility. Memory aids, organizer tools and modified routines compensate for residual deficits. Support groups provide critical information and emotional support for caregivers. While behavioral modification programs address secondary conditions like substance abuse and lifestyle risk factor management promotes long-term well-being.
Pharmacological Treatments For TBI
No drugs have been established as definite treatment for core TBI symptoms though symptomatic relief options exist. Acute anticontusion drugs have not shown clear benefits in most extensive research trials. Corticosteroids reduce edema in early TBI but preclude delayed neurological deterioration. FDA approved seizure prevention medications control posttraumatic epilepsy satisfactorily.
Off-label options like amantadine and levetiracetam show promise for subacute cognitive impairment though larger long-term studies are needed. Psychotropic drugs may help post-TBI mood, psychiatric and behavioral issues but selection must consider drug interactions carefully due to cytochrome P450 enzyme changes after brain injury. Neuroprotectants targeting excitotoxicity, oxidative stress like progesterone and antioxidants show mixed evidence due to trial design flaws.
Stem cell and gene therapies prototyping different delivery methods including MSCs, NSCs and exosomes are currently being explored in preclinical and early phase clinical trials. Their safety, long-term benefits and mechanism optimization holds promise for neuroregeneration if proven efficacious in future rigorously designed larger clinical trials evaluating functional outcomes not just surrogate endpoints like imaging markers. Many ongoing studies aim to validate these groundbreaking approaches.
The Road Ahead
While significant progress has been made in understanding brain injury pathophysiology and developing supportive therapies, a definitive treatment addressing primary deficits remains elusive. Current research emphasizes developing biomarkers to precisely stage injury pathology, predict outcomes, and guide personalized combinatorial medical- rehabilitation approaches. Advanced neuroimaging is shedding light on structural-functional connectivity changes post-injury and facilitating targeted treatments. Promising avenues include optimization of neuroprotective and regenerative treatments, gene therapies, electromagnetic and robotic devices, virtual reality aided rehabilitation, preventive measures like improved safety gears and validation of alternative therapies like nutraceuticals. A multipronged strategy across the continuum of injury, focused on individualized
management holds the key to maximize recovery outcomes from this debilitating condition.
Get More Insights On Brain Injury Therapeutics
Ravina Pandya, Content Writer, has a strong foothold in the market research industry. She specializes in writing well-researched articles from different industries, including food and beverages, information and technology, healthcare, chemical and materials, etc. With an MBA in E-commerce, she has an expertise in SEO-optimized content that resonates with industry professionals. (https://www.linkedin.com/in/ravina-pandya-1a3984191)
