An acquired brain injury (ABI) changes everything and the repercussions are multifold, resulting in physical complications, cognitive difficulties, as well as emotional and behavioural challenges.
ABI refers to any brain damage caused after birth which can occur because of disease, infection, lack of oxygen, stroke, alcohol and drug use, or from a physical injury.
When there is brain damage because of a blow to the head, it is known as traumatic brain injury (TBI), a major cause of lifelong disability and death worldwide.
It is estimated that for each year more than 11,000 Queenslanders are expected to acquire a brain injury, of which 4,000 will develop a serious disability and 70% will sustain traumatic brain injuries due to motor vehicle accidents, according to Queensland Health.
Treatment for ABI
Immediate treatment for brain injury involves minimising secondary damage to brain tissue and stabilising the patient. After which begins the long road to recovery, including rehabilitation and medication.
Brain injury is complex with a range of symptoms and disabilities. Depending on the outcome of the brain injury and the type of difficulties, treatment options can vary. These might include physical, occupational or speech therapy, counselling, social support and psychiatric services.
Breakthrough treatments for ABI
Researchers are constantly investigating aspects of brain injury and treatment options to help people with ABI recover as much as possible from the effects of the injury.
In recent years, scientists have been thinking out of the box and have made some potential discoveries that hold promise for ABI.
Here are seven notable breakthrough discoveries for ABI treatment:
Note: The following are medical study findings at various stages of trials, some early stage. This is not medical advice. You should seek expert medical advice from your health professional for any advice on medications or treatments.
The most common emotional and behavioural symptoms experienced by ABI patients are aggression and anger.
Mood swings and sudden outbursts affect their relationship with family and friends, making it difficult for them to live with loved ones as well as maintain a steady job. Aggression also results in poor rehabilitation outcomes for them.
Cognitive behaviour therapy (CBT) and counselling are usually recommended as the best treatment options for mental and emotional health. However, in some cases, antidepressants are also prescribed to reduce aggressive behaviour.
Interestingly, in 2017, a study found that the antiviral medication Amantadine shows promise as a treatment for aggression and anger following TBI.
The study discovered that taking 100 mg of the drug twice daily reduced aggression in patients with brain injury.
Amantadine is no longer used as an antiviral but is used to treat symptoms of Parkinson’s disease. Because it is used for Parkinson’s disease, doctors may recommend Amantadine off label for ABI, although there is not enough research into the drug for brain injury.
2: Perispinal Etanercept
Another drug with promising results in reducing symptoms of brain injury is Etanercept, normally used for arthritis.
An initial 2010 study discovered that this drug improved chronic neurological dysfunction from stroke or traumatic brain injury even years after the event, with a single dose.
Etanercept targets brain inflammation caused by trauma to the brain, which can remain high for many years after a traumatic event.
Brain inflammation can affect memory, mood, thinking processes, motor function (balance, reflex, and coordination), and sensory function such as hearing and vision. It also causes behavioural and psychological problems, resulting in significant disability.
The efficiency of Etanercept is further amplified when administered using the perispinal method, which involves injecting the drug into the spine to enter the vascular system.
This method of delivery enables the drug to penetrate the cerebrospinal fluid—which surrounds the brain and the spinal cord—resulting in improvements in patients with chronic neurological dysfunction following stroke and TBI.
Currently, the treatment is under trial led by Professor Stephen Ralph of Griffith University’s School of Medicine, who said that a number of larger trials were needed before Australia’s Therapeutic Goods Administration would consider the treatment.
3: Stem cell therapy
Various studies in cell therapy have shown the usefulness of stem cells in helping patients with TBI.
Studies indicate that stem cell therapy can improve neurological and motor function and reduce inflammation, a major cause of degeneration after a brain injury. Cell therapy is also useful in improving cognitive function and preserving brain tissue.
Another study suggests that adult neural stem cells may play a regenerative role in repairing the injured brain.
Adult stem cells are found in various parts of the body, such as skin, marrow, brain, and muscles. Unlike other cell types, these cells can develop into cells with a specific function, such as a skin cell, a nerve cell, or a muscle cell. Thus, stem cells can replace or heal damaged tissues and cells, including the ones affected in a brain injury.
Although stem cell therapy shows potential to change the way patients with ABI are treated, a lot more research is still needed to uncover the full potential of stem cell therapy for brain injury.
Currently, researchers are investigating the use of stem cells to treat a range of brain conditions, including ABI.
In Australia, stem cell treatment is not yet approved for use except to treat certain disorders of the blood or the immune system, including cancers.
4: “M-type” proteins
One of the common symptoms after TBI is the occurrence of seizures, which can lead to the development of epilepsy.
However, an experimental treatment conducted on mice by a team of researchers at the University of Texas Health Science Center at San Antonio may provide a breakthrough treatment in preventing brain damage right after injury and thus reduce seizures.
Certain proteins in the body known as KCNQ (Kv7, “M-type”) K+ can stop sudden and uncontrolled electrical activity in the nerve cells.
The researchers found that by increasing the administration of “M-type” channels, it reduces a host of TBI-induced events, including cell death, inflammation, blood-brain barrier (cells that protect the brain) breakdown, and seizures, that can lead to brain damage.
The manipulation of these “M-type” proteins has been studied extensively as a treatment option for epilepsy. But now research has turned to the investigation of M-type channels for brain injury prevention and multiple brain disorders as a suitable treatment for humans.
A traumatic brain injury increases the risk of developing neurodegenerative diseases later in life, such as Alzheimer’s disease and Parkinson’s disease—conditions that cause brain cells to deteriorate.
Medications that might help prevent such diseases after TBI are difficult to deliver to the brain because of the protection provided by the blood-brain barrier.
The only way for doctors to deliver medication is after a head injury when the blood-brain barrier is breached. This window of opportunity is short and often unpredictable, as the barrier can self-repair within a few hours to a few days after an injury.
To enable administration of medication when the barrier is intact, a team of researchers engineered nanoparticles to carry a TBI drug to the brain, according to a 2021 study published in Science Advances.
This drug is called “small interfering RNA (siRNA)” which can silence gene expression and targets specific biological pathways to reduce the progression of disease.
For the study, the researchers used a particular siRNA designed to slow down tau—a protein linked to neurodegenerative conditions like Alzheimer’s.
They found that when they delivered optimised nanoparticles to mice with TBI, there was a 50% reduction in tau even when the nanoparticles were given late in an injury (after the blood-brain barrier had been restored).
The nanoparticle platform certainly shows great promise in treating TBI and other neurological disorders, spurring researchers to explore and develop this technology further for human testing.
6: Virtual reality
In gaming, virtual reality (VR) has certainly made its mark. But recent research demonstrating the therapeutic potential of VR suggests this technology can be helpful in rehabilitation for traumatic brain injuries.
TBI leads to several negative long-term consequences that affect cognitive functioning like memory, problem-solving, attention and executive function (such as planning, self-control, and regulation of emotions).
Emerging studies show VR can improve cognitive functioning in adults and children. It also proves to be useful in improving mood and reducing anxiety and depression, which often accompany cognitive dysfunction.
However, at this point, there is not enough research that can validate the inclusion of VR as a therapeutic tool for TBI.
Another technology making waves is Neuralink, a gadget or a computer chip that is surgically implanted in the brain. The chip is connected to tiny wires inserted in areas of the brain that control movement.
The idea behind Neuralink is to connect the human brain and technology so that people can use the neural activity in their brain to directly control a phone, a computer, or any other device just by thinking about it.
This means that people with brain injuries, spinal cord injuries, paralysis, or neurodegenerative diseases can use this neuroscience technology to communicate as well as do other activities like play games, draw, or take photographs.
However, the development of Neuralink will take time before it can be tested on humans safely.
Hope for the future
Scientists are making new discoveries every day that can change the future of people with ABI, giving hope that there is always a potential new treatment option on the horizon.