Abstract
Many drugs with proven efficacy in the preclinical stage have failed to show any benefit in improving the outcome of severe traumatic brain injury (TBI) when tested in controlled clinical trials. Hypothermia is still the most powerful neuroprotective method in experimental models of TBI. Its ability to influence the multiple biochemical cascades that are set in motion after TBI is quite unique. In experimental models hypothermia protects against mechanical neuronal and axonal injury and improves behavioral outcome. Encouraging results from phase II and III clinical trials of hypothermia in TBI reported in the 1990s generated great enthusiasm. However, enthusiasm faded in 2001 after the final report of the multicenter phase III trial in which the neuroprotective effects of moderate hypothermia in TBI were formally tested. This study found no significant effect on outcome in the hypothermia group, leading many clinicians to lose interest in this therapy. The present article reviews the historical background of the use of hypothermia, presents the rationale for using both immediate and deferred hypothermia, and summarizes both experimental and clinical evidence supporting its potential benefits in the management of severe TBI. New technologies using intravascular methods to induce fast hypothermia have recently become available. Cooling either through the intravenous or intra-arterial route is an exciting alternative with great potential. We argue that moderate hypothermia is still the most powerful neuroprotective candidate for severe TBI and that it merits further research and discussion. We also defend the need for further clinical trials to prove or refute its potential for treating high intracranial pressure refractory to first level therapeutic measures. The premature abandonment of hypothermia could close new avenues for improving the devastating effects of TBI.
Keywords: traumatic brain injury, hypothermia, high intracranial pressure, intravascular cooling methods, neuroprotection
Current Pharmaceutical Design
Title: Moderate Hypothermia in the Management of Severe Traumatic Brain Injury: A Good Idea Proved Ineffective?
Volume: 10 Issue: 18
Author(s): J. Sahuquillo, M. P. Mena, A. Vilalta and M. A. Poca
Affiliation:
Keywords: traumatic brain injury, hypothermia, high intracranial pressure, intravascular cooling methods, neuroprotection
Abstract: Many drugs with proven efficacy in the preclinical stage have failed to show any benefit in improving the outcome of severe traumatic brain injury (TBI) when tested in controlled clinical trials. Hypothermia is still the most powerful neuroprotective method in experimental models of TBI. Its ability to influence the multiple biochemical cascades that are set in motion after TBI is quite unique. In experimental models hypothermia protects against mechanical neuronal and axonal injury and improves behavioral outcome. Encouraging results from phase II and III clinical trials of hypothermia in TBI reported in the 1990s generated great enthusiasm. However, enthusiasm faded in 2001 after the final report of the multicenter phase III trial in which the neuroprotective effects of moderate hypothermia in TBI were formally tested. This study found no significant effect on outcome in the hypothermia group, leading many clinicians to lose interest in this therapy. The present article reviews the historical background of the use of hypothermia, presents the rationale for using both immediate and deferred hypothermia, and summarizes both experimental and clinical evidence supporting its potential benefits in the management of severe TBI. New technologies using intravascular methods to induce fast hypothermia have recently become available. Cooling either through the intravenous or intra-arterial route is an exciting alternative with great potential. We argue that moderate hypothermia is still the most powerful neuroprotective candidate for severe TBI and that it merits further research and discussion. We also defend the need for further clinical trials to prove or refute its potential for treating high intracranial pressure refractory to first level therapeutic measures. The premature abandonment of hypothermia could close new avenues for improving the devastating effects of TBI.
Export Options
About this article
Cite this article as:
Sahuquillo J., Mena P. M., Vilalta A. and Poca A. M., Moderate Hypothermia in the Management of Severe Traumatic Brain Injury: A Good Idea Proved Ineffective?, Current Pharmaceutical Design 2004; 10 (18) . https://dx.doi.org/10.2174/1381612043384051
DOI https://dx.doi.org/10.2174/1381612043384051 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Chemotherapy and Targeted Agents for Elderly Women with Advanced Breast Cancer
Recent Patents on Anti-Cancer Drug Discovery Disease-Induced Neuroinflammation and Depression
CNS & Neurological Disorders - Drug Targets Colloid Update
Current Pharmaceutical Design NPFF2 Receptor is Involved in the Modulatory Effects of Neuropeptide FF for Macrophage Cell Line
Protein & Peptide Letters Ghrelin as a Neuroprotective and Palliative Agent in Alzheimer's and Parkinson's Disease
Current Pharmaceutical Design Oxidative Stress: Apoptosis in Neuronal Injury
Current Alzheimer Research Misoprostol Reverse Hippocampal Neuron Cyclooxygenase-2 Downstream Signaling Imbalance in Aluminum-Overload Rats
Current Alzheimer Research Nanotechnology Based Diagnostic and Therapeutic Strategies for Neuroscience with Special Emphasis on Ischemic Stroke
Current Medicinal Chemistry Device-based Therapies for Resistant Hypertension
Current Pharmaceutical Design Inflammation: Beneficial or Detrimental After Spinal Cord Injury?
Recent Patents on CNS Drug Discovery (Discontinued) Genomics and the Prospects of Existing and Emerging Therapeutics for Cardiovascular Diseases
Current Pharmaceutical Design Targeted Drug Delivery to Central Nervous System (CNS) for the Treatment of Neurodegenerative Disorders: Trends and Advances
Central Nervous System Agents in Medicinal Chemistry An Update on Drug Interactions with the Herbal Medicine Ginkgo biloba
Current Drug Metabolism Melatonin and Its Therapeutic Potential in Neuroprotection
Central Nervous System Agents in Medicinal Chemistry Substance P in Rheumatic Diseases
Current Rheumatology Reviews Therapeutic Strategies to Target Multiple Kinases in Glioblastoma
Anti-Cancer Agents in Medicinal Chemistry The Potential Role of Sirtuins Regarding the Effects of Exercise on Aging- Related Diseases
Current Aging Science Recent Advances on the Roles of NO in Cancer and Chronic Inflammatory Disorders
Current Medicinal Chemistry Can Decision Making Research Provide a Better Understanding of Chemical and Behavioral Addictions?
Current Drug Abuse Reviews Texture-Based Classification of Periventricular Leukomalacia in Preterm Ultrasound Images
Current Medical Imaging