Progress in brain research
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Acute spinal cord injury (SCI) is a devastating neurological disorder that can affect any individual at a given instance. Current treatment options for SCI include the use of high dose methylprednisolone sodium succinate, a corticosteroid, surgical interventions to stabilize and decompress the spinal cord, intensive multisystem medical management, and rehabilitative care. ⋯ These include the Surgical Treatment for Acute Spinal Cord Injury Study (STASCIS) Trial to evaluate the role and timing of surgical decompression for acute SCI, neuroprotection with the semisynthetic second generation tetracycline derivative, minocycline; aiding axonal conduction with the potassium channel blockers, neuroregenerative/neuroprotective approaches with the Rho antagonist, Cethrin; the use of anti-NOGO monoclonal antibodies to augment plasticity and regeneration; as well as cell-mediated repair with stem cells, bone marrow stromal cells, and olfactory ensheathing cells. This review overviews the pathobiology of SCI and current treatment choices before focusing the rest of the discussion on the variety of promising neuroprotective and cell-based approaches that have recently moved, or are very close, to clinical testing.
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Ischemia is a common problem after traumatic brain injury (TBI) that eludes detection with standard monitoring. In this review we will discuss four available techniques (SjVO2, PET, NIRS and PbrO2) to monitor cerebral oxygenation. We present technical data including strengths and weaknesses of these systems, information from clinical studies and formulate a vision for the future.
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Among the secondary events occurring after traumatic brain injury (TBI) pathologically increased intracranial pressure (ICP) correlates most closely with poor outcome. In addition to infusion of hypertonic solutions, e.g. mannitol, and other medical measures, decompression of the brain by surgical removal of a portion of the cranium (craniectomy) has been used for many decades as an intuitive strategy for the treatment of post-traumatic ICP increase. The lack of evidence-based clinical and controversial experimental data, however, resulted in decompressive craniectomy to be recommended by most national and international guidelines only as a third tier therapy for the treatment of pathologically elevated ICP. ⋯ The aim of the current review was therefore to summarize and discuss recent experimental data dealing with the use of decompression craniectomy following TBI. The present results suggest that surgical decompression effectively prevents secondary brain damage when performed early enough. Although caution should be taken when transferring conclusions drawn from experimental settings to the clinical situation, the current literature suggests that the timing of decompression may be of utmost importance in order to exploit the full neuroprotective potential of craniectomy following TBI.
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Tinnitus has many similarities with the symptoms of neurological disorders such as paresthesia and central neuropathic pain. There is considerable evidence that the symptoms and signs of some forms of tinnitus and central neuropathic pain are caused by functional changes in specific parts of the central nervous system and that these changes are caused by expression of neural plasticity. ⋯ In this chapter we will discuss specific similarities between tinnitus and pain, and compare tinnitus with other phantom disorders. Since much more is known about pain than about tinnitus, it is valuable to take advantage of the knowledge about pain in efforts to understand the pathophysiology of tinnitus and find treatments for tinnitus.
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Preterm birth is a risk factor for deficits of neurological and cognitive development. Four cohort studies are reported investigating the effects of very premature birth (<32 weeks gestation) on visual, visuocognitive and visuomotor function between birth and 6-7 years of age. The first study used two measures of early visual cortical function, orientation reversal visual event-related potentials (OR-VERP) and fixation shifts under competition. ⋯ Development was generally relatively normal on language tests and on WPPSI scores. Factor analysis showed that while general cognitive ability accounted for the largest part of the variance, significant deficits, and a relationship to MRI results, were primarily in spatial, motor, attention and executive function tests. A model is proposed suggesting that the cluster of deficits seen in children born prematurely may be related to networks involving the cortical dorsal stream and its connections to parietal, frontal and hippocampal areas.