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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_353"
                     title="Helmets Linked to Reduced Head Injury Risk in Alpine Sports (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Neurology/HeadTrauma/tb/18227?impressionId=1265778101303"
                     
      Skiers and snowboarders have a significantly lower risk of head injury if they wear helmets, a meta-analysis showed.&lt;br&gt;
&lt;br&gt;In a pooled analysis of nine studies, helmet wearers were 35% less likely to suffer a head injury than those without helmets (OR 0.65, 95% CI 0.55 to 0.79), Brent Hagel, PhD, of the University of Calgary in Alberta, and colleagues reported online in the &lt;em&gt;Canadian Medical Association Journal&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;The association was significant for skiers and snowboarders alike.&lt;br&gt;
&lt;br&gt;Although there has been some concern that use of a helmet could increase the risk of neck injury because of the extra weight it adds to the head, especially with children, the studies did not confirm any danger.&lt;/p&gt;
&lt;p&gt;&quot;Based on our findings, we encourage the use of helmets among skiers and snowboarders,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;Various reports have estimated that 9% to 19% of injuries that occur on the slopes are head injuries and 1% to 4% are neck injuries.&lt;/p&gt;
&lt;p&gt;Traumatic brain injury is the leading cause of death and serious injury among skiers and snowboarders.&lt;/p&gt;
&lt;p&gt;A recent example was the training accident of U.S. Olympic hopeful snowboarder Kevin Pearce, who suffered a severe traumatic brain injury when he fell and hit his head on the edge of a half pipe on New Year&apos;s Eve. He was wearing a helmet.&lt;/p&gt;
&lt;p&gt;Although injury prevention efforts in alpine activities have focused on helmets, there were no systematic reviews of their effectiveness, the new study&apos;s authors noted.&lt;/p&gt;
&lt;p&gt;So Hagel and colleagues assembled data from 10 case-control studies, one case-control/case-crossover study, and one cohort study, totalling 9,829 participants who were wearing helmets and 36,735 who weren&apos;t. The studies evaluated head injury, neck injury, or both.&lt;/p&gt;
&lt;p&gt;In addition to protecting adults from head injury, the researchers found, helmets also appeared to protect children younger than 13 (OR 0.39, 95% CI 0.23 to 0.65).&lt;/p&gt;
&lt;p&gt;While two of four studies looking at potentially severe head trauma  --  resulting in referral to an emergency physician or hospital for treatment or evacuation by ambulance  --  found a reduced risk in those wearing helmets, the other two found no effect.&lt;/p&gt;
&lt;p&gt;There was some evidence that risk of head injury was reduced for males wearing helmets, but not for females, although sex was not found to be a significant modifier of the relationship between helmet use and injury risk (&lt;em&gt;P&lt;/em&gt;=0.09).&lt;/p&gt;
&lt;p&gt;Helmet use was not associated with risk of neck injury, even among children, which &quot;is consistent with biomechanical data showing no increase in neck loads associated with helmet use in simulated snowboarding falls,&quot; the researchers noted in the journal.&lt;/p&gt;
&lt;p&gt;The meta-analysis had some limitations, they wrote, including the moderate methodologic quality of the included studies, two different approaches for determining control groups (noninjured skiers and snowboarders versus those with injuries not involving the head or neck), the inclusion of English-language studies only, and variations in confounders, definitions of head injury, and places of and personnel involved in diagnosis.&lt;/p&gt;
&lt;p&gt;In addition, the researchers were unable to examine the results in terms of the design, quality, or fit of the helmets for cases.&lt;/p&gt;
&lt;p&gt;&quot;Methodologically rigorous research is required to determine which types of helmets provide the best protection,&quot; they wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding was received for the study.&lt;/p&gt;&lt;p&gt;Hagel holds the Alberta Children&apos;s Hospital Foundation Professorship in Child Health and Wellness, funded through the support of an anonymous donor and the Canadian National Railway Company. He also holds a Population Health Investigator Award from the Alberta Heritage Foundation for Medical Research and a New Investigator Award from the Canadian Institutes of Health Research.&lt;/p&gt;&lt;p&gt;One of his co-authors holds a doctoral studentship from the Alberta Heritage Foundation for Medical Research.&lt;/p&gt;&lt;p&gt;The authors reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_168"
                     title="Concussion Label Can be Confusing (CME/CE)"
                     score="-0.003"
                     href="http://www.medpagetoday.com/Neurology/HeadTrauma/tb/18000?impressionId=1265778101303"
                     
      Whether a clinician calls a mild traumatic brain injury a concussion or not appears to influence how serious the injury is considered to be, researchers found.&lt;br&gt;
&lt;br&gt;Among children admitted for a traumatic brain injury, those who were told they had a concussion were discharged significantly earlier (OR 1.49, 95% CI 1.15 to 1.94) and returned to school sooner (OR 2.42, 95% CI 1.56 to 3.73) than those who were not given the label, Carol DeMatteo, MSc, of McMaster University in Hamilton, Ontario, and colleagues reported in the February issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;The trends remained significant even after adjusting for the severity of the head injury and the presence of other injuries.&lt;/p&gt;
&lt;p&gt;&quot;We suggest that the [concussion] label itself conveys a message and also directs outcomes,&quot; the researchers wrote. &quot;If we want to encourage full reporting with subsequent adequate management and convalescence, perhaps we should use the term &apos;mild traumatic brain injury.&apos;&quot;


 &lt;p&gt;Disagreeing was Kenneth Perrine, PhD, a neuropsychologist at Hackensack University Medical Center in New Jersey.
    &lt;p&gt;&quot;Granted, concussion is by definition a mild brain injury, but it&apos;s so transient that I think it would be a disservice both to the public and for research to continue to confuse mild traumatic brain injury with concussion,&quot; said Perrine, who was not involved in the study.
    &lt;p&gt;He said a true concussion is characterized by feeling like one is in a fog, fatigue, sensitivity to light and sound, headache, blurred vision or other visual disturbances, and feeling off balance.
    &lt;p&gt;A mild traumatic brain injury, on the other hand, has longer-lasting effects and is not usually accompanied by concussion symptoms. Retrograde amnesia, post-traumatic amnesia, and more severe memory loss would occur, he said.
    &lt;p&gt;&quot;They are two distinct entities both from what we call it and from a prognostic standpoint,&quot; said Perrine, who is also consulting neuropsychologist for the New York Jets.
    &lt;p&gt;But, although the term concussion is used widely in clinical records and has garnered much attention in recent years because of head injuries to athletes at all levels of sports, an accepted definition does not exist, according to DeMatteo and her colleagues.&lt;/p&gt;


&lt;p&gt;&quot;Clinicians may use the concussion label because it is less alarming to parents than the term &quot;mild brain injury,&quot; with the intent of implying that the injury is transient with no signi&amp;#64257;cant long-term health consequences,&quot; they said.&lt;/p&gt;

&lt;p&gt;Commenting on the study, Wendy Wright, MD, a neurologist at Emory University in Atlanta, said in an e-mail, &quot;This study puts a spotlight on the issue that concussion is not always taken as seriously as it should be, partly because concussion encompasses a spectrum of disease.&quot;&lt;/p&gt;
&lt;p&gt;She said parents, coaches, teammates, and the individual with the concussion may not believe the injury is serious because symptoms are transient.&lt;/p&gt;
&lt;p&gt;That perception appears to be held by both clinicians and parents alike. DeMatteo and colleagues noted in the journal that during recruitment of the current study, both groups were heard saying, &quot;He doesn&apos;t have a head injury, he has a concussion.&quot;&lt;/p&gt;
&lt;p&gt;However, Wright said, &quot;it must be noted that concussion means brain injury.&quot;&lt;/p&gt;


&lt;p&gt;To explore how the term is used clinically, DeMatteo and colleagues analyzed the records of 434 children admitted to McMaster Children&apos;s Hospital with a diagnosis of acquired brain injury.&lt;/p&gt;
&lt;p&gt;Of those determined to have a traumatic brain injury, 72.7% had a mild injury according to the Glasgow Coma Scale. Nearly one-third (32.4%) were said to have a concussion.&lt;/p&gt;
&lt;p&gt;The concussion label was more likely to be given to children with a mild injury (&lt;em&gt;P&lt;/em&gt;=0.03), but the association was weak, according to the researchers, and nearly one-quarter (24%) of children with moderate or severe scores were also said to have a concussion.&lt;/p&gt;
&lt;p&gt;&quot;This leads one to question the use of the term as being reflective of mild injury and again supports the existence of confusion about what a concussion really is and how the term should best be used in the care of children,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;Our findings, both in the return-to-school data and the phenomenon we experienced during recruitment, suggest that if a child is given a diagnosis of concussion, then the family is less likely to consider it as a brain injury,&quot; the researchers said.&lt;/p&gt;
&lt;p&gt;They acknowledged some limitations of the study, including the fact that data from medical charts may have had missing information and a lack of control over the validity of measurements and that their use of only a single center might influence the results.&lt;/p&gt;
&lt;p&gt;Further, they wrote, some measures, such as CT frequency, might be inflated because only children who were admitted to the hospital were included in the study. &lt;ul&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by a research grant from the Ontario Neurotrauma Foundation. The &lt;em&gt;CanChild&lt;/em&gt;&lt;em&gt;&lt;/em&gt; Center for Childhood Disability Research is supported by the Ontario Ministry of Health and Long-Term Care.&lt;/p&gt;&lt;p&gt;The authors reported that they had no relevant financial disclosures to make.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_2903"
                     title="Rules Can Guide Use of CT After Head Trauma (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Neurology/HeadTrauma/tb/15975?impressionId=1265778101303"
                     
      &lt;p&gt;More than one-fifth of children who receive CT scans following head trauma don&apos;t need them, researchers found.&lt;/p&gt;
&lt;p&gt;Applying simple, validated rules showed that 20.1% of children 2 and older and 24.1% of those younger than 2 who received CT scans had a low risk of serious brain injury, Nathan Kuppermann, MD, MPH, of the University of California Davis, and colleagues reported online in &lt;em&gt;The Lancet&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;For these children, the risk of developing cancer because of radiation exposure outweighs the risk of clinically important traumatic brain injuries, including those resulting in death, neurosurgery, intubation for longer than 24 hours, or hospital admission for at least two nights, they said.&lt;/p&gt;
&lt;p&gt;Previous studies have suggested that CT scans were being overused for pediatric head trauma, but they were subject to various limitations, including small sample size and lack of validation or independent assessment in children younger than 2, according to the researchers.&lt;/p&gt;
&lt;p&gt;So, using a derivation cohort of 33,785 children, Kuppermann and colleagues developed rules for classifying children as low risk. These children would not need CT scans.&lt;/p&gt;
&lt;p&gt;Older children are considered low-risk if they have normal mental status, no loss of consciousness, no vomiting, no signs of basilar skull fracture, and no severe headache, and did not sustain their injury in a serious accident.&lt;/p&gt;
&lt;p&gt;Because children younger than 2 are generally unable to communicate their symptoms, are more sensitive to the effects of radiation, and have different mechanisms of injury, the researchers said, they needed slightly different rules.&lt;/p&gt;
&lt;p&gt;Those who had normal mental status, no scalp swelling except frontal, no loss of consciousness more than five seconds, and no palpable skull fracture, and were acting normally according to the parents and sustained their injury in a non-severe way were classified as low risk.&lt;/p&gt;
&lt;p&gt;&quot;Application of these rules could limit CT use, protecting children from unnecessary radiation risks,&quot; Kuppermann and colleagues wrote.&lt;/p&gt;
&lt;p&gt;The rules are not, however, meant to replace the judgment of an individual clinician, they said, but rather, &quot;these rules provide the necessary data to assist clinicians and families in CT decision making after head trauma.&quot;&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, Patricia Parkin, MD, and Jonathan Maguire, MD, of the Hospital for Sick Children in Toronto, wrote that &quot;these researchers have not only addressed an important clinical question, but have also provided a powerful example of the science behind clinical decision making.&quot;&lt;/p&gt;
&lt;p&gt;The study included 42,412 children with signs of minor head trauma treated at 25 hospitals, sought to address some of those shortcomings. The data came from the the Pediatric Emergency Care Applied Research Network (PECARN).&lt;/p&gt;
&lt;p&gt;Overall, 35.3% of the children received CT scans. Serious brain injuries were diagnosed in only 376 (0.9%) and only 60 (0.1%) required neurosurgery.&lt;/p&gt;
&lt;p&gt;When the researchers&apos; rules were applied to a validation cohort of 8,627 children, they accurately predicted 100% of those under 2 who did not require CT scans and were not diagnosed with serious brain injuries. Sensitivity was 100%.&lt;/p&gt;
&lt;p&gt;The rules for older children correctly predicted 99.5% who did not require CT scans; the sensitivity was 96.8%.&lt;/p&gt;
&lt;p&gt;The researchers noted that not all children who do not fall into the low-risk group necessarily need to have CT scans. The use of imaging in these children should be based on physician experience, severity and number of symptoms, and other factors, such as parental preference, they said.&lt;/p&gt;
&lt;p&gt;They noted some limitations of the study, including the inability to obtain CT scans from all patients, the low rate of CT use compared with the national average, and the lack of information on long-term neurocognitive outcomes.&lt;/p&gt;
&lt;p&gt;Parkin and Maguire, the editorialists, raised two other issues.&lt;/p&gt;
&lt;p&gt;Although the sensitivities of the rules were high, they said, they were not perfect. The lower confidence limits were 93% in both age groups in the derivation cohort and 86% for the younger age group and 89% for the older age group in the validation cohort.&lt;/p&gt;
&lt;p&gt;&quot;Predicting clinically important traumatic brain injury in children might be sufficiently complex that it might be difficult for a rule with six predictors to achieve perfect sensitivity,&quot; they said. &quot;Yet rules with a greater number of predictors might be impractical.&quot;&lt;/p&gt;
&lt;p&gt;Also, if the rules were strictly implemented in a clinical setting, the predicted rate of CT use would actually be higher than found in the study, they said.&lt;/p&gt;
&lt;p&gt;&quot;To address these issues, Kuppermann and colleagues remind us that the rules are meant to inform clinical decision making, not to replace it,&quot; they said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;PECARN is supported by cooperative agreements from the Emergency Medical Services for Children program of the Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services. The study was also supported by a grant from the Maternal and Child Health Bureau Research Program.&lt;/p&gt;&lt;p&gt;Both the study authors and the editorialists reported that they have no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_2974"
                     title="Drinkers More Likely to Survive Head Injury (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Neurology/HeadTrauma/tb/16065?impressionId=1265778101303"
                     
      &lt;p&gt;Having alcohol in the blood stream appeared to cut death rates among people suffering severe head injuries, but also increased the likelihood of complications, researchers said.&lt;/p&gt;
&lt;p&gt;Records of more than 38,000 victims of traumatic brain injury showed that individuals with detectable blood alcohol levels were 12% less likely to die in the hospital (adjusted OR 0.88, 95% CI 0.80 to 0.96), according to Ali Salim, MD, of Cedars-Sinai Medical Center in Los Angeles, and colleagues.&lt;/p&gt;
&lt;p&gt;But those who had alcohol in the blood were 24% more likely to suffer complications from a head injury (adjusted OR 1.24, 95% CI 1.15 to 1.33), the researchers reported in the September issue of &lt;em&gt;Archives of Surgery&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The odds ratios reflected controls for such factors as age, type of injury, Glasgow Coma Scale score, Injury Severity Score, comorbidities, and blood pressure.&lt;/p&gt;
&lt;p&gt;Besides the decreased in-hospital mortality and increased complication rates, the study also identified several other associations with the presence of alcohol in the head-injury patients: &lt;ul&gt; &lt;li&gt;Mean duration of ICU stay: 7.3 days with alcohol, 7.7 days without (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001)&lt;/li&gt; &lt;li&gt;Mean time spent on a ventilator: 7.9 days with alcohol, 8.7 days without (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001)&lt;/li&gt; &lt;li&gt;Mean total Functional Independence Measure score: 10.3 with alcohol, 10.0 without (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The researchers pointed out that it is established beyond doubt that alcohol dramatically increases the risk of severe injury and death in the first place, so they were not advocating that people drink before engaging in activities that might cause head injuries.&lt;/p&gt;
&lt;p&gt;On the other hand, they said the study &quot;raises the intriguing possibility that administering ethanol to patients with brain injuries may improve outcome.&quot;&lt;/p&gt;
&lt;p&gt;The study was &quot;the largest database review on this topic to date,&quot; Salim and colleagues wrote.&lt;/p&gt;
&lt;p&gt;The apparent survival benefit associated with alcohol was not unprecedented  --  some small clinical studies had yielded a similar conclusion. But neither those nor the current study provided a definitive explanation for the effect.&lt;/p&gt;
&lt;p&gt;The researchers said animal experiments had suggested a variety of neuroprotective mechanisms that may be at work: closer coupling of glucose metabolism and cerebral blood flow, inhibition of cytokine release, and less excitotoxicity mediated by the N-methyl-D-aspartate receptor complex.&lt;/p&gt;
&lt;p&gt;&quot;Additional research is warranted to investigate reasons for this association and the potential therapeutic implications,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;The analysis was based on records in the National Trauma Data Bank of patients with brain injuries occurring from 2000 to 2005.&lt;/p&gt;
&lt;p&gt;The researchers focused on individuals with isolated moderate to severe traumatic brain injuries in whom blood alcohol was tested  --  which excluded more than 34,000 otherwise eligible cases in which testing was not performed.&lt;/p&gt;
&lt;p&gt;The exclusion may well have been important, because the untested patients differed significantly from those ultimately included in the analysis in many respects. Those not tested for ethanol were older, less severely injured, more likely to be female, and more likely to die before discharge.&lt;/p&gt;
&lt;p&gt;The exclusions represent &quot;an inherent selection bias&quot; that was an important limitation to the study, Salim said.&lt;/p&gt;
&lt;p&gt;For example, he said in an exchange with Edward E. Cornwell III, MD, a trauma surgeon at Howard University in Washington, published with the study, &quot;it is very possible ethanol testing is done by the better-equipped trauma centers.&quot; Such centers may also be more likely to send case records to the data bank, he said.&lt;/p&gt;
&lt;p&gt;For his part, Cornwell said the study was &quot;important because it is emblematic of the challenges associated with outcomes research.&quot;&lt;/p&gt;
&lt;p&gt;He said Salim and colleagues used appropriate statistical analysis, but worried that the underlying data were too skimpy to rule out other explanations for the findings.&lt;/p&gt;
&lt;p&gt;In addition to selection bias, Cornwell said that insurance status  --  which was not recorded in the data bank  --  could have influenced outcomes significantly. Salim agreed, although he said that research has not consistently supported such influence.&lt;/p&gt;
&lt;p&gt;Other limitations included lack of detailed information on blood alcohol levels at the time of the injury or on patients&apos; history of drinking. The researchers also did not analyze potential associations between alcohol and outcomes of specific types of brain injury, which might differ.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;External funding for the study was not reported.&lt;/p&gt;&lt;p&gt;Salim and Cornwell declared they had no potential conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_4176"
                     title="Progesterone Called Option for Brain Injury Treatment"
                     score="-0.005"
                     href="http://www.medpagetoday.com/CriticalCare/HeadTrauma/tb/17652?impressionId=1265778101303"
                     
      &lt;p&gt;Progesterone should be considered as treatment option for head trauma  --  and perhaps other types of central nervous system injuries, researchers urged.&lt;/p&gt;
&lt;p&gt;The hormone&apos;s beneficial effects on neuronal survival and functional recovery following traumatic brain injury have been sufficiently documented that its clinical use is now justified, according to Donald G. Stein, PhD, of Emory University, and his recent collaborator there, Iqbal Sayeed, PhD.&lt;/p&gt;
&lt;p&gt;&quot;There are now about 100 preclinical studies from laboratories in the U.S. and abroad showing the beneficial effects of progesterone treatment in a number of central nervous system injury models,&quot; Stein and Sayeed wrote in a &quot;clinical perspective&quot; article appearing in the January 2010 issue of the &lt;em&gt;American Journal of Roentgenology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;They also pointed to two clinical trials, one in the U.S. and one in China, showing a that short course of progesterone improved function more than placebo in patients with traumatic brain injury. (See &lt;a href=&quot;http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/4224&quot; mce_href=&quot;http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/4224&quot; target=&quot;_blank&quot;&gt;Progesterone Cuts 30-Day Mortality from Traumatic Brain Injury&lt;/a&gt; and &lt;a href=&quot;http://www.medpagetoday.com/Neurology/HeadTrauma/9278&quot; mce_href=&quot;http://www.medpagetoday.com/Neurology/HeadTrauma/9278&quot; target=&quot;_blank&quot;&gt;Progesterone Improves Head Injury Recovery&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Stein has been studying the effects of sex hormones on brain function after injury for more than 20 years, primarily in animal models. But he was also an investigator in the U.S. clinical trial, which was led by another Emory colleague, David Wright, MD.&lt;/p&gt;
&lt;p&gt;In that study, with 100 patients, 30-day mortality following head trauma was cut to 13% with progesterone compared with 30% in a placebo group. The 159-patient Chinese trial found that six-month mortality was reduced by about 40%.&lt;/p&gt;
&lt;p&gt;In these trials, progesterone was given by injection or infusion over several days following injury. No adverse effects attributable to the hormone treatment were reported.&lt;/p&gt;
&lt;p&gt;Stein and Sayeed suggested that, given this safety profile and the current lack of effective treatments for severe brain injuries, that it would be appropriate to consider progesterone as a treatment option.&lt;/p&gt;
&lt;p&gt;&quot;More than 30 years of testing and 30 trials involving 50 compounds failed to identify an acute-stage treatment for traumatic brain injury that could confer neuroprotection and enhance functional outcomes,&quot; they asserted.&lt;/p&gt;
&lt;p&gt;They also pointed out the high frequency of brain injuries suffered by troops in Iraq and Afghanistan.&lt;/p&gt;
&lt;p&gt;Stroke is also largely untreatable, Stein and Sayeed argued. &quot;Aside from tissue plasminogen activator (tPA), which can be given to only about 3% of stroke victims and only during the first three to four hours after stroke onset, nothing is available for clinical use,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;No clinical trials of progesterone in stroke are planned, they acknowledged, and stroke differs in important ways from traumatic brain injury.&lt;/p&gt;
&lt;p&gt;Progesterone has shown promise in preclinical stroke models but studies of how it behaves in conjunction with tPA should precede clinical application, the researchers recommended.&lt;/p&gt;
&lt;p&gt;Stein and Sayeed added that animal studies have found that progesterone may also help in acute spinal cord injury as well as chronic neurodegenerative conditions such as diabetic retinopathy, Niemann-Pick C1 syndrome, and multiple sclerosis.&lt;/p&gt;
&lt;p&gt;The exact mechanism for progesterone&apos;s neuroprotective effects are unknown, but Stein and Sayeed offered an evolutionary hypothesis for why they might exist.&lt;/p&gt;
&lt;p&gt;They noted that progesterone levels are highest in pregnant women and they remain high throughout gestation.&lt;/p&gt;
&lt;p&gt;&quot;It is our contention that progesterone&apos;s mechanisms of action have evolved primarily to protect the developing fetus against oxidative stress and immune&amp;#8211;inflammatory rejection reactions,&quot; the researchers wrote, adding that the hormone also helps regulate neuronal development.&lt;/p&gt;
&lt;p&gt;&quot;Many of the processes of CNS repair recapitulate the steps taking place during development, and this is why we think that progesterone may also show promise in the treatment of traumatic and degenerative disorders of the brain and CNS.&quot;&lt;/p&gt;
&lt;p&gt;They concluded, &quot;Given its relatively high safety profile, its ease of administration, and its low cost and ready availability, this hormone and its metabolites should be considered as a viable treatment option  --  especially because, in brain injury, so little else is currently available.&quot;&lt;/p&gt;

    </recommendedItem>
</recommendedContent>