Research Reports - Pharmacologic neuroprotection for functional outcomes after traumatic brain injury

CNS Drugs. 2016 Jun 23. [Epub ahead of print]

Gruenbaum SE(1), Zlotnik A(2), Gruenbaum BF(1), Hersey D(3), Bilotta F(4).

INTRODUCTION: Traumatic brain injury (TBI) is a major cause of death and
disability worldwide. The deleterious effects of secondary brain injury may be
attenuated by early pharmacological therapy in the emergency room and intensive
care unit (ICU). Current medical management of acute TBI is primarily supportive,
aimed at reducing intracranial pressure (ICP) and optimizing cerebral perfusion.
There are no pharmacological therapies to date that have been unequivocally
demonstrated to improve neurological outcomes after TBI.
OBJECTIVES: The purpose of this systematic review was to evaluate the recent
clinical studies from January 2013 through November 2015 that investigated
neuroprotective functional outcomes of pharmacological agents after TBI.
METHODS: The following databases were searched for relevant studies: MEDLINE
(OvidSP January Week 1, 2013-November Week 2 2015), Embase (OvidSP 2013 January
1-2015 November 24), and the unindexed material in PubMed (National Library of
Medicine/National Institutes of Health [NLM/NIH]). This systematic review
included only full-length clinical studies and case series that included at least
five patients and were published in the English language. Only studies that
examined functional clinical outcomes were included.
RESULTS: Twenty-five of 527 studies met our inclusion criteria, which
investigated 15 independent pharmacological therapies. Eight of these therapies
demonstrated possible neuroprotective properties and improved functional
outcomes, of which five were investigated with randomized clinical trials:
statins, N-acetyl cysteine (NAC), Enzogenol, Cerebrolysin, and nitric oxide
synthase inhibitor (VAS203). Three pharmacological agents did not demonstrate
neuroprotective effects, and four agents had mixed results.
CONCLUSIONS: While there is currently no single pharmacological therapy that will
unequivocally improve clinical outcomes after TBI, several agents have
demonstrated promising clinical benefits for specific TBI patients and should be
investigated further. 

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