Abstract
 

Traumatic Brain Injury: an urgent call for treatments….in acute and chronic phase

Traumatic brain injury (TBI), mostly due to falls and accidents, is the leading cause of death and disability in young adults. The incidence in elderly patients is increasing. Importantly severe TBI is related to 4.5 times increased risk of Alzheimer disease. Recent large international observational studies show variability in acute treatments of severe TBI patients, but unfortunately these differences are not related to clinical outcome. This warrants the development of new concepts and ideas.

Marcel Aries: An attractive option is to individualize (perfusion) treatment guided by continuous physiological cerebral measurements on the intensive care. This concept is boosted by our recent completed (feasibility and safety) COGITATE multi-center study. A large outcome study will be designed in close collaboration with the research team of the Limburg Brain Injury Center (MHeNS division 1) to formulate relevant endpoints and follow-up. We also hope to take advantage of lessons learned by the intense COVID-19 pandemic showing the importance of understanding the inflammatory and coagulation response to severe injury. COVID medications might also be beneficial to treat the acute or subacute inflammation observed after severe TBI. As there is no vaccination for TBI, prevention of accidents is of utmost importance. For example, by wearing bicycle helmets.  
 
Caroline van Heugten: After successful acute medical treatment, life after surviving a severe TBI starts. Currently, there is no systematic follow-up care for this vulnerable patient group showing long-term and often lasting consequences in many areas of functioning. In later stages after injury the focus shifts from a pure biomedical approach to a biopsychosocial approach. The ultimate aim is to optimize a patients daily functioning and societal participation. Here we also learn from the COVID-pandemic: how do we treat long-term consequences if the cause is unknown or cannot be altered?