Elective neurotraumatology and therapeutic strategies in early post-trauma

The aim of elective neurotraumatology is to outline new and valid therapeutic strategies in early post-trauma in order to obtain a more favourable long-term outcome for cranial and spinal trauma patients than usually achieved with conventional intensive therapies. After a critical review of all drugs and measures currently used for the treatment of damage due to cerebral trauma and a brief mention of new agents still being studied, the results of a retrospective study of 128 patients with severe head injury are reported. For all patients a complete clinical and pharmacological history of their traumatic event, which had occurred from 5 to 14 years before the present evaluation, was available. Eighty-nine had undergone traditional therapies and 39 had been given complementary neuroprotective drugs, variously associated with traditional therapies. There was no statistically significant difference between the groups in terms of the global clinical outcome, (assessed by a 5-point scale: death, worsening, unchanged condition, improvement, recovery), and some sequelae, such as decubitus, impairment of sphincter control, neurological focal deficits and post-traumatic epilepsy. On the contrary, cognitive impairment and depression resulted statistically less frequent in patients who underwent conventional therapies and early complementary neuroprotective treatments than in the controls. In conclusion it would be very interesting to perform controlled clinical studies to confirm these preliminary results and the effectiveness of early neuroprotection on the long-term clinical outcome of patients with severe head injury. The therapeutic approach in early post-trauma is still not completely standardised and the purpose of elective neurotraumatology is to emphasise and promote the importance of such a standardisation.