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The brain is made up of billions of cells called neurons, which consist of a cell body called a soma, a tail called an axon and projections called dendrites. The axons providing extensive interconnections between brain areas and are frequently damaged even in minor head injury. There are numerous research projects which are investigating how to minimise the initial damage that brain suffers in an injury, later damage it can suffer and also how to maximise rehabilitation.
When axons are harmed, called diffuse axonal injury, they swell and disconnect from the soma. The neuron also starts releasing toxic levels of chemical messengers into the synapse or space between neurons, damaging neighbouring neurons. Neurons that were unharmed in the initial injury cannot survive the toxicity of the chemicals and so die. This process usually takes place in the first 24 - 48 hours after the initial injury. A promising area of research is studying using various specialised chemicals to prevent calcium ions causing cell death and brain tissue swelling.
The brain attempts to repair itself after injury, more successfully after mild or moderate injury than after severe injury. After diffuse axonal injury neurons can spontaneously sprout some remaining healthy fibres into the space left by the dead axon, sometimes resuming communication with neighbouring neurons. This very delicate process can be disrupted by low oxygen levels and low blood flow or excessive neuroexcitation, the electrical activation of nerve cells, which can cause sprouting fibres to connect with the wrong terminals.
These misconnections may contribute to pain, spasticity, seizures, and memory problems. So researchers are trying to learn more about the brain's natural recovery process, in the hope that they can increase its repair while decreasing misconnections.
Using stem cells to repair damaged brain tissue is an exciting avenue. A neural stem cell is found in adult neural tissue and normally develops into several different cell types found in the central nervous system. Researchers are investigating using stem cells to develop neurotransmitter producing neurons and a type of brain cell that produces myelin, the fatty sheath that insulates axons. Currently, stem cell research for brain injury is in early stages, but may lead to advances in treatment and rehabilitation.
Scientists are also studying the brain’s plasticity after injury. Plasticity in this sense means the ability of the brain to adapt to deficits and injury. Researchers are investigating developing therapies to enhance plasticity as a way of restoring function.
Scientists in particular, who have long known that the brains of children are better able to adapt and recover from injury than the brains of adults, are investigating why this is so. They think that children have more neural networks than they need, many of which naturally decrease, but when an injury destroys an important neural network in children, another less useful neural network that would have eventually died takes over the responsibilities of the damaged network.
Another important area of research involves the development of improved rehabilitation programmes for those who have disabilities from a traumatic brain injury, with the goal of designing therapies to restore normal brain function.
As part of the work to develop treatment in the first hours after a traumatic brain injury, bearing in mind the damage the injured brain can cause to the healthy parts, a recent trial involved lowering body temperature of brain injury patients in the first 8 hours. It was found that the treatment did not improve overall outcome, but it was learnt that patients younger than 45 years who were taken to hospital already with hypothermia, did better if they were kept cool and not brought to normal body temperature.
Clinical research is increasing all the time our understanding of how the injured brain can continue to injure itself, as well as how it attempts to repair damage. Hopefully this insight as well as stem cell research, will lead to the better management of acute brain injury along with later rehabilitation. If you or a loved one has suffered a brain injury which was someone else's fault, please contact Ian Shovlin or call on 0800 073 0988 to see how we can help.
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