J Korean Med Assoc.
2024 Dec;67(12):743-751. 10.5124/jkma.2024.67.12.743.
Current advances in treatment for traumatic brain injury
- Affiliations
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- 1Trauma Center, Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
- KMID: 2563310
- DOI: http://doi.org/10.5124/jkma.2024.67.12.743
Abstract
- Background
Traumatic brain injury (TBI) refers to a disruption in brain function or evidence of brain pathology caused by external physical forces. Globally, TBI affects approximately 50 million individuals annually, with nearly half of the population experiencing it at some point in their lives. Severe TBI is associated with a high mortality rate (30–40%) and long-term physical, psychological, and social impairments in up to 60% of cases. TBI ranges from scalp injuries to severe intracerebral damage, with severity assessed by injury severity scores and consciousness levels (Glasgow coma scale). Diffuse axonal injuries (DAI) cause minimal anatomical damage with severe loss of consciousness, affecting treatment and prognosis.
Current Concepts
TBI treatment focuses on hemostasis and intracranial pressure (ICP) management to achieve the main goal of preventing secondary brain injury. Early avoidance of hypotension and hypoxia is crucial. Recent advancements include: first, multimodal brain monitoring by utilizing invasive and non-invasive ICP methods, brain oxygenation measurement, and cerebral blood flow assessments for early detection and treatment guidance; second, using biomarkers for TBI (such as GFAP, S100B, NSE, NFL, UCH-L1, and IL-1β) for diagnosis and prognosis prediction; third, target temperature management in which hypothermia therapy reduces ICP and controls inflammation; and fourth, investigating novel pharmacological therapeutics like corticosteroids, progesterone, erythropoietin, amantadine, and anticonvulsants, although several large-scale trials have revealed a lack of significant benefits.
Discussion and Conclusion
TBI remains a leading cause of mortality with unresolved challenges. Research has focused on optimizing neuro-intensive care protocols, developing evidence-based surgical treatments, and exploring promising neuroprotective pharmacotherapies. Given TBI’s pathological heterogeneity, personalized medicine and combination therapies are crucial, as no single treatment addresses all mechanisms. Advancements in monitoring technologies and biomarker development are expected to significantly enhance diagnosis, prognosis prediction, and tailored treatment strategies.
