March is Brain Injury Awareness Month, observed by The Brain Injury Association of America (BIAA) (hyperlink: Brain Injury Association of America | BIAA (biausa.org)) to raise awareness about the significance of brain injuries and their links to death and impairment in America. This year’s campaign: #MoreThanMyBrainInjury gives individuals a chance to overcome those definitions, allowing them to tell their own stories and change the narrative of their lives.

Traumatic brain injury (TBI) is a perennial pandemic and continues to remain a major cause of morbidity and mortality, globally. Over the years, novel therapeutic strategies have been tried and implemented with some success in managing patients with head injury. Variations between centers reveals high therapy intensity level treatments like metabolic suppression, hypothermia, hyperventilation, and secondary decompressive craniectomy. These are often not proceeded by more conventional lower interventions using an inappropriate escalation strategy while impacting the outcome. Despite the availability of new guidelines, the question remains unanswered, on how to manage patients with head injury in the era of novel translational treatments.

Translational research is the process of applying knowledge from basic research and clinical trials to techniques and tools that address bedside medical needs. The goal of translational research is to move basic science discoveries quickly and efficiently into clinical practice. Traumatic head injury is one such clinical condition which still requires explanation in terms of translational research. In acute brain injury, in comparison to primary insult, secondary insults play a significant role in increasing the morbidity and mortality of the patients. As of now, there is no definitive therapy that restores the neuronal integrity after traumatic brain injury and that calls for translational research with an aim to prevent secondary injury.

In my recently published book on Perioperative Neuroscience: Translational Research, authors Pelosi and colleagues, have contributed an excellent chapter on the pharmacological and non-pharmacological perspectives in relation to translational research and head injury.  Issues that have been addressed are related to the usage of drugs such as sedatives, osmotic agents, analgesics, anti-epileptics, steroids, tranexamic acid, and prophylaxis for infections and deep venous thrombosis. Some novel drugs such a methylphenidate, lithium, quetiapine, phenserine tartrate, memantine, and galantamine showing interesting properties have also been discussed. Some of the non-pharmacological strategies discussed by the authors includes ventilatory management, drainage of cerebrospinal fluid, decompressive craniectomy and therapeutic hypothermia.

However, despite the existence of new guidelines, the appropriate management of head injury is still under investigation, especially regarding nonconventional pharmacological treatments. Head injury treatment and management are continuously evolving over the years. Although current guidelines do not include the use of novel pharmacological and nonpharmacological agents yet, but experimental and clinical data show promising results. Novel translational strategies may help improve and treat head injury patients in the near future.

Perioperative Neuroscience: Translational Research examines current clinical research focused on complications and the improvement of patient outcomes in neuroanesthesia and neurocritical care. Some of the key features of this book are as follows –

• Addresses translational developments in pharmacogenomics, brain protection and neurotoxicity
• Discusses ethical concerns relevant to clinical research in perioperative neuroscience
• Collates insights from international experts in translating research to practice

The book addresses important translational topics including neuroanesthetics, pharmacogenomics, neuroprotection and neurotoxicity. In addition, it covers special considerations for topics such as stroke, traumatic brain injury and pain, as well as for specific patient populations like geriatric and pediatric.

An excellent source of essential topics on translational research in perioperative neurosciences, this book is a must for all trainees as well as clinicians.

Find The A Requisite for Translational Research in Head injury in the Elsevier store

Hemanshu Prabhakar, MD, Ph.D., FSNCC(Hon)

Professor, Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India

#MoreThanMyBrainInjury