Scientists Explore Use of Hormones Following Traumatic Brain Injury

Traumatic brain injuries (TBI) have been receiving a lot of attention lately because of the large number of such injuries suffered by soldiers in Iraq and Afghanistan, and the risk of concussions in sports like football and hockey. But many TBI incidents are caused by car accidents or car-pedestrian accidents. In the elderly, many brain injuries are caused by falls. Often these falls occur when patients are left unsupervised in hospitals or nursing homes.

According to the federal Centers for Disease Control and Prevention, about 1.7 million people a year experience a traumatic brain injury in the United States. Of those, 275,000 are hospitalized, and more than 50,000 die. More than 5 million Americans are estimated to suffer from a long-term disability following such injuries. The direct medical expenses and indirect costs, including lost productivity, have been estimated at $76 billion a year, according to the C.D.C.

Now scientists are examining the use of progesterone, the reproductive hormone, to help TBI patients. The new study, described in the New York Times, was financed by the National Institutes of Health and overseen by Emory University in Atlanta. The purpose of the study is to test the hypothesis that the hormone can reduce mortality and disability if administered right after a traumatic brain injury.

Progesterone appears to affect multiple physiologic processes that follow an acute injury. It reduces the cerebral swelling that leads to brain cells dying off, for example. Progesterone also may blunt cellular damage from free radicals and promote myelin production in damaged nerve cells, experts believe.

Patients must begin the infusion within four hours of the injury, with outcomes assessed after six months. Dr. David Gordon, an assistant professor of neurosurgery at Montefiore Medical Center in the Bronx, is not involved in the research, but he said he has “some measure of cautious optimism” about progesterone. “The early data look very promising,” he said.

In 2007, researchers at Emory reported that in a trial of 100 patients, the mortality rate after 30 days among brain-injured patients who received progesterone was just 13 percent, compared with 30 percent among those given a placebo. Patients with moderate traumatic brain injury who were given progesterone experienced greater functional improvement. A small study from China also reported positive outcomes with the hormone.

The idea that progesterone might lessen the effects of brain injury originated with Donald Stein, a neuroscientist and a professor of emergency medicine at Emory. Decades ago, he noticed that female rats, especially those with the high levels of progesterone typical during pregnancy, were better than male rats at remembering certain tasks, like how to swim through a water maze after an induced brain injury.

“Although we think of it as a female hormone, there are a lot of clues in nature that this compound has multiple roles in the human body,” said Dr. David Wright, an associate professor of emergency medicine at Emory who is lead investigator of the current clinical trial.
Small amounts of progesterone are found in the brains of both women and men, suggesting that it has neuroprotective as well as reproductive functions.

The Emory trial will include 1,140 participants at trauma centers around the country. Results are expected within three years, although a monitoring board will examine preliminary results this summer and could halt the study if the data suggest that the drug is highly effective.

Kreisman Law Offices has been handling Illinois brain injury cases for more than 35 years in and around Chicago, Cook County, and surrounding areas, including Chicago’s Bridgeport neighborhood, Skokie, Calumet City, and Orland Park.