Classification of Traumatic Brain Injury for Targeted Therapies

Abstract

The heterogeneity of traumatic brain injury (TBI) is considered one of the most significant barriers to finding effective therapeutic interventions. In October, 2007, the National Institute of Neurological Disorders and Stroke, with support from the Brain Injury Association of America, the Defense and Veterans Brain Injury Center, and the National Institute of Disability and Rehabilitation Research, convened a workshop to outline the steps needed to develop a reliable, efficient and valid classification system for TBI that could be used to link specific patterns of brain and neurovascular injury with appropriate therapeutic interventions. Currently, the Glasgow Coma Scale (GCS) is the primary selection criterion for inclusion in most TBI clinical trials. While the GCS is extremely useful in the clinical management and prognosis of TBI, it does not provide specific information about the pathophysiologic mechanisms which are responsible for neurological deficits and targeted by interventions. On the premise that brain injuries with similar pathoanatomic features are likely to share common pathophysiologic mechanisms, participants proposed that a new, multidimensional classification system should be developed for TBI clinical trials. It was agreed that preclinical models were vital in establishing pathophysiologic mechanisms relevant to specific pathoanatomic types of TBI and verifying that a given therapeutic approach improves outcome in these targeted TBI types. In a clinical trial, patients with the targeted pathoanatomic injury type would be selected using an initial diagnostic entry criterion, including their severity of injury. Coexisting brain injury types would be identified and multivariate prognostic modeling used for refinement of inclusion/exclusion criteria and patient stratification. Outcome assessment would utilize endpoints relevant to the targeted injury type. Advantages and disadvantages of currently available diagnostic, monitoring, and assessment tools were discussed. Recommendations were made for enhancing the utility of available or emerging tools in order to facilitate implementation of a pathoanatomic classification approach for clinical trials.

Recombinant Human Interleukin-1 Receptor Antagonist in Severe Traumatic Brain Injury: A Phase II Randomized Control Trial

“…There are several overlapping modes of injury in TBI (e.g., contusion, extraaxial hematoma, and diffuse injury with axonal shearing) that may have distinct pathologic mechanisms with different host inflammatory responses. 25 Previous rodent models of IL1ra antagonism in TBI have used variations of the controlled cortical impact model. [3][4][5][6] In this study, we have tried to minimize interpatient variability rather than recapitulating these rodent models; however, this does not detract from the core conclusions of the study.…”

Management of Dysphagia Following Traumatic Brain Injury

“…Oral Motor Exercises and TBI Patients with diffuse TBIs present heterogeneous pathoanatomical injury features and pathophysiological mechanisms behind their neurological symptoms [99]. Motor impairment following TBI depends on the site/s of injury and can include spasticity, weakness, ataxia, apraxia and extrapyramidal movement disorders [100].…”

Phosphodiesterase‐5 inhibition potentiates cerebrovascular reactivity in chronic traumatic brain injury

“…Despite success in animal models, all Phase III human clinical trials to date have failed 7, 8, 9, 10. Consensus conferences have concluded that biomarkers will be critical for the development of effective TBI therapies targeted at injury‐specific mechanisms 6, 11…”