Pharmacological treatment of head injury--a new challenge.

Abstract

Thcrc arc currcntly no demonstrably cffcctivc trcatmcnts for hcad injury. Wc bclicvc that there is at least preliminary evidence that a number of drugs could potentially prove extremely beneficial in the treatment of human head injury. We also believe that the medical community has not attended sufficiently to the clinical potential of thc drugs cxamincd in animal experiments. For cxample, data from our own laboratories indicate that treatment with anticholinergic agents could significantly improve clinical outcome in at least moderately head injured patients [l, 2,3]. It is important to note that benefits from drug treatment may not be restricted to anticholinergic agents. Data from Feeney’s laboratory [4] indicate that administration of catecholaminergic agents may also provide some benefits for head injured patients. The approaches from these two laboratories represent classical pharmacological strategies of manipulating neurotransmitter functions. Other pharmacological strategies for treating head injury may include the use of opiate antagonist agents [5], neuronal regeneration enhancing agents such as gangliosides [6], or agents that protect cell membrane integrity such as calcium channel blockers [7,8]. Thus, we find ourselves at a critical junction in studies designed to improve the treatment of head injured patients. Laboratory data have described a variety of compounds which may prove beneficial. However, no systematic clinical studies have exploited these laboratory findings. We do not wish to imply that researchers in head injury have ignored the need for pharmacological approaches to head injury. Indeed, in this premiire issue of Brain Injury, several papers deal with issues of pharmacological treatment of head injury. For example, Weinberg et al. presents a case study, using pharmacological treatment with neurotransmitter agonists, suggesting that specific pharmacotherapy may result in cognitive functional improvement in brain injured patients. Parmelee and O’Shanick present case reports illustrating the practical applications of neuropsychopharmacological approaches to the treatment of head injured children and adolescents. And in a paper related to pharmacological issues, Feeney and co-workers present further evidence supporting their hypothesis of the role of catecholamines in the recovery of function after brain injury. It is useful to recall that pharmacological approaches have proved extremely beneficial in the treatment of other central nervous system pathologies. These pathologies include depression, schizophrenia, and, more recently, epilepsy and Parkinson’s disease. Such observations further suggest that pharmacological approaches to the treatment of head injury could be extremely productive. We wish to strongly advocate systematic evaluations of the effectiveness of various pharmacological agents in the treatment of human head injury. Studies with small numbers of patients and data not subjected to careful statistical analyses are of limited value in developing clinical approaches that are generally applicable. Thus, evaluations of pharmacological treatment must take place as rigorously organized clinical trials aimed at active treatment of the pathological processes attending head injury.