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2016 ; 30
(9
): 791-806
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
Pharmacologic Neuroprotection for Functional Outcomes After Traumatic Brain
Injury: A Systematic Review of the Clinical Literature
#MMPMID27339615
Gruenbaum SE
; Zlotnik A
; Gruenbaum BF
; Hersey D
; Bilotta F
CNS Drugs
2016[Sep]; 30
(9
): 791-806
PMID27339615
show ga
INTRODUCTION: Traumatic brain injury (TBI) is a major cause of death and
disability worldwide. The deleterious effects of secondary brain injury may be
attenuated by early pharmacological therapy in the emergency room and intensive
care unit (ICU). Current medical management of acute TBI is primarily supportive,
aimed at reducing intracranial pressure (ICP) and optimizing cerebral perfusion.
There are no pharmacological therapies to date that have been unequivocally
demonstrated to improve neurological outcomes after TBI. OBJECTIVES: The purpose
of this systematic review was to evaluate the recent clinical studies from
January 2013 through November 2015 that investigated neuroprotective functional
outcomes of pharmacological agents after TBI. METHODS: The following databases
were searched for relevant studies: MEDLINE (OvidSP January Week 1, 2013-November
Week 2 2015), Embase (OvidSP 2013 January 1-2015 November 24), and the unindexed
material in PubMed (National Library of Medicine/National Institutes of Health
[NLM/NIH]). This systematic review included only full-length clinical studies and
case series that included at least five patients and were published in the
English language. Only studies that examined functional clinical outcomes were
included. RESULTS: Twenty-five of 527 studies met our inclusion criteria, which
investigated 15 independent pharmacological therapies. Eight of these therapies
demonstrated possible neuroprotective properties and improved functional
outcomes, of which five were investigated with randomized clinical trials:
statins, N-acetyl cysteine (NAC), Enzogenol, Cerebrolysin, and nitric oxide
synthase inhibitor (VAS203). Three pharmacological agents did not demonstrate
neuroprotective effects, and four agents had mixed results. CONCLUSIONS: While
there is currently no single pharmacological therapy that will unequivocally
improve clinical outcomes after TBI, several agents have demonstrated promising
clinical benefits for specific TBI patients and should be investigated further.