UCSF Experts Call for Overhauling Treatment, Research of Traumatic Brain Injury

By Robin Hindery

Chief resident Isaac Yang, MD, performs a pupillary and Glasgow Coma Scale exam on a traumatic brain injury patient at San Francisco General Hospital as Geoff Manley, MD, PhD, SFGH chief of neurotrauma and UCSF professor of neurological surgery, watches over the entire team in the background.

The recent death of actress Natasha Richardson has put a famous face on traumatic brain injury (TBI), which kills roughly 50,000 people in the United States every year. But when the headlines shift to other topics and the current flurry of public interest in TBI subsides, there will remain a pressing need for increased awareness and improved treatment of these potentially life-altering — but also often treatable — injuries, says Geoff Manley, MD, PhD, UCSF professor of neurological surgery and internationally recognized neurotrauma expert. The majority of TBI victims — who number about 1.4 million annually — are treated and released from the emergency department, but TBI remains a major cause of death and disability. The Centers for Disease Control and Prevention (CDC) estimates that 5.3 million Americans are currently living with long-term or permanent mental and physical impairments as a result of a TBI. Studies over the past two decades have revealed much about the biological mechanisms behind TBI, but there has been a serious lag when it comes to translating that knowledge into a successful clinical trial and improved patient care, said Manley, who co-directs the UCSF Brain and Spinal Injury Center and is chief of neurotrauma at UCSF-affiliated San Francisco General Hospital. “There have been more than two dozen failed clinical trials, and no substantial progress in taking the kind of research we do at UCSF and translating it to the clinical arena,” Manley said. “Even the way we classify TBI is completely outdated.” The current classification system, known as the Glasgow Coma Scale, divides a patient’s TBI into the extremely broad categories of mild, moderate and severe, and fails to take into account the specifics of each patient’s condition, Manley said. What is needed is a new classification system and an overall standardization of treatment and research efforts, he said. “If we can start to standardize, we can really change the field,” Manley said. “Only by standardizing can we make things more efficient, streamlined and economical.” Manley and other TBI experts from nearly 50 agencies and institutions will be tackling these issues at a consensus conference in Silver Spring, Maryland, on March 23-24. The conference is co-sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, the National Institutes of Health, and the US Department of Veterans Affairs. Manley said he hopes the conference will produce real results that can be immediately applied to TBI clinical trials, including one scheduled to take place at UCSF later this year — the ProTECT trial — that will study the use of progesterone in the treatment of acute brain injury.

Increasing Awareness

In the long term, he said, overhauling the way TBI is currently studied and treated could prevent tragedies like the one that befell Richardson. The actress, who was injured in a fall while skiing, died March 18 of a large blood clot compressing her brain — a condition known as epidural hematoma — according to New York City’s medical examiner. The bleeding that led to the clot was caused by “blunt impact to the head,” the medical examiner said. Manley called Richardson’s condition “totally treatable” and said if she had received prompt medical attention and surgery, she likely would have survived. “It’s truly a matter of awareness,” he said. “Everybody believes cancer or heart disease could happen to them, but nobody really believes they’re going to walk across the street and someone is going to run them over. For whatever reason, people don’t want to believe they are going to sustain a head injury, despite the fact that TBI remains one of the leading causes of death under the age of 45.” Appreciating the potential danger of head injuries and taking the proper precautions are “just not part of the fabric of our culture,” Manley said. “That’s something that has to change.” Photo by Susan Merrell

Related Links:

Manley Laboratory at UCSF

UCSF Research at SFGH Helps Critically Injured Neurotrauma Surgeon Geoff Manley
School of Medicine, May 22, 2007

Pushing the Limits to What Is Medically Possible--Patient Story: Crystal Elmendorf
School of Medicine, May 22, 2007