Accessibility Panel

TBI affects millions of patients worldwide annually, and many suffer severe disability and death. It is a highly complex disease, making severity of injury challenging to classify. TBI classification still depends on the Glasgow Coma Scale which was developed in 1974. It uses a simplistic three-tier system of mild moderate, and severe. This study aims to allow TBI diagnosis to follow in the footsteps of neuro-oncology.

Researchers hope the innovations in diagnosis and treatment they are currently investigating for TBI will help patients with TBI in the future. Treating mild TBI and concussions requires an out-of-the-box thinking approach, researchers say. 

New research proposes that biochemical analysis of brain tissue could be used to diagnose and treat severe traumatic brain injury, improve patient outcomes, and save billions in future clinical trials.

A study printed in Biomedicines Journal looks at the changes taking place at a cellular and molecular level in the injured brain in the acute phase. The study included 25 adult patients – with brain biopsies obtained shortly after injury undergoing specialized immunohistochemistry analysis. 

This analysis revealed formerly unknown biomolecular and cellular changes, allowing researchers to 'score' the severity of injury using their novel grading system.

The researchers could gain vital information about the type and severity of the patient's injuries, meaning they could determine whether they may benefit from specific treatments.

For instance, Immunohistochemical investigation can help decide the need for an invasive surgical but lifesaving technique to remove skull segments. This treatment choice is currently determined on clinical insight with little robust evidence.

Neuroimaging techniques currently used to diagnose TBI, such as CT and MRI, lack the resolution to detect cellular and molecular changes. The information established in this study adds significantly to the diagnostic tools available. The methods have been distinguished to show results within 12 hours, meaning that the data is available early on in the patient's treatment.

We believe this could revolutionize how we diagnose TBI in patients and pave the way to finding effective treatments. Inadvertently, testing a single treatment on a variety of conditions means that if a patient does benefit, they are concealed within a larger group that does not help, and the trial fails.

More than $1 billion has been spent globally on clinical trials of more than 30 drugs over the past 25 years,  and all have failed to show any advantage in severe traumatic brain injury. The possible reason, which this research is the first to demonstrate, is that brain injury is a range of issues rather than a single disease. 

"A useful comparator is cancer treatment: all cancers cannot be treated with a single drug, regardless of their type or severity, and the same principle applies to brain injury.

Different drugs may also improve outcomes in patients depending on their injury type, which may already be available. We need to unlock their potential with the precise diagnosis, which is where biomolecular and cellular analysis can be helpful."

Brain biopsy is used frequently in brain cancer diagnosis. The study shows it is safe for patients with severe TBI to undergo brain biopsies. This means that this procedure can be further investigated and refined, potentially benefitting patients worldwide.