Pharmaceuticals
Progesteron in the Treatment of Brain Injury
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Traumatic brain injuries kill 50,000 Americans and disable 80,000 more each year. About 5 million patients are living with a disability from a head injury. Doctors can only provide supportive care at this point. Barbiturates, mannitol and surgery are sometimes used to relieve pressure inside the skull that occurs when a victim's brain swells, but these last-resort measures do not always work. As a result, the activities of daily living, such as the ability to concentrate, feed one's self, wake up in the morning, and remember tasks becomes difficult.
Progesterone occurs naturally in small amounts in the brains of animals and humans. The hormone has been used safely for decades to treat several conditions in men and women. Although it may slightly increase the risk of blood clots in the legs or lungs, researchers believe the risk is minimal. Scientists from Emory University are collaborating on what they says is the world's first clinical trial to use the hormone progesterone as a treatment for moderate to severe traumatic brain injury.
In animal studies, progesterone improved memory and cognitive thinking skills. Rats developed less brain swelling and recovered more completely when treated shortly following injury. The hormone seems to moderate the inflammation that frequently leads to dangerous brain swelling following head injury. It also seems to slow or block a cascade of damaging chemicals, known as free radicals, which are released by traumatic injury. Progesterone seems to protect the brain from the breakdown in nerves, neurons and other cells within the brain after injury.
After the initial trauma, a secondary injury occurs over hours, days, weeks and months. That secondary injury is what goes on to increase injury size and cause death. "We now have a drug, potentially, that could halt the process of cell death after the initial event," said emergency room Dr. David Wright.
Four out of every five patients in the blinded study will be given progesterone by intravenous infusion for three days. The remaining patients will be given a placebo of intravenous fluid without progesterone. Participants will then be evaluated for mental functioning on discharge from the hospital and at one month following injury.
So far, Wright says, there have been no harmful side effects and what they are observing in patients looks promising. Researchers say progesterone could potentially work for strokes, spinal cord injury, and several other neurologic diseases with little or no available treatments.
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