What is the treatment for traumatic injury to the nervous system (NS)?

From the Guidelines

Treatment of traumatic injury to the nervous system requires immediate medical attention, with a focus on stabilizing the patient, maintaining adequate oxygenation, and controlling intracranial pressure, as outlined in the most recent guidelines 1. The management of traumatic brain injury (TBI) involves a multifaceted approach, including medications such as mannitol (0.25-1 g/kg IV) or hypertonic saline (3% solution at 0.5-1 mL/kg/hr) to reduce brain swelling, and anti-seizure prophylaxis with levetiracetam (500-1000 mg twice daily) or phenytoin (loading dose 15-20 mg/kg IV, then 100 mg three times daily) in the first week after severe injury. For spinal cord injuries, high-dose methylprednisolone (30 mg/kg IV bolus followed by 5.4 mg/kg/hr for 23 hours) may be considered if administered within 8 hours of injury, though its use remains controversial, as noted in previous studies 1. Surgical intervention may be necessary to remove blood clots, repair damaged tissue, or decompress the spinal cord. Rehabilitation is crucial and should begin as early as possible, involving physical therapy, occupational therapy, and speech therapy as needed, with the goal of maximizing functional recovery through comprehensive rehabilitation programs tailored to each patient's specific injuries and needs, as emphasized in recent clinical policies 1. Pain management often includes gabapentin (300-1200 mg three times daily) or pregabalin (75-300 mg twice daily) for neuropathic pain. Targeted temperature control (TTC) is also an important aspect of TBI management, as it can help prevent further brain injury and improve neurological outcome, according to recent best-practice consensus recommendations 1. Overall, the treatment of traumatic injury to the nervous system prioritizes preventing secondary damage, promoting neural plasticity, and maximizing functional recovery, with a focus on individualized care and evidence-based guidelines. Key considerations include:

• Maintaining adequate perfusion pressure, with specific hemodynamic goals defined for different types of injuries, such as systolic blood pressure (SBP) > 110 mmHg and/or cerebral perfusion pressure (CPP) between 60 and 70 mmHg for moderate-severe TBI 1
• Controlling intracranial pressure and preventing secondary injury, through measures such as TTC and surgical intervention
• Providing comprehensive rehabilitation and pain management, tailored to each patient's specific needs and injuries.

From the FDA Drug Label

High doses of systemic corticosteroids, including methylprednisolone sodium succinate, should not be used for the treatment of traumatic brain injury.

The treatment for traumatic injury to the nervous system (NS) with methylprednisolone is not recommended, especially for traumatic brain injury, as it may increase mortality. 2

From the Research

Treatment for Traumatic Injury to the Nervous System (NS)

• The treatment for traumatic injury to the nervous system (NS) is focused on relieving symptoms and rehabilitation, as CNS lesions are often incurable 3.
• Methylprednisolone is a commonly used treatment for acute traumatic spinal cord injury, but its effectiveness is still controversial 4, 5.
• Some studies have found that methylprednisolone does not enhance ASIA motor score improvement in the lower extremities at 26 weeks 4, and may even increase the risk of complications 5.
• An interdisciplinary treatment approach, consisting of intensive conservative and operative treatment options in specialized centers, is necessary for effective treatment of traumatic injuries to the CNS 6.
• Emergency providers should maintain a high index of suspicion for peripheral and central nervous system injuries, especially in the setting of polytrauma, and work to minimize secondary injury 7.
• Surgical specialists may be needed for closed reduction, surgical decompression, or stabilization of spinal cord injuries 7.
• The prognosis for traumatic injuries to the CNS depends on the area damaged and the extent of the lesion, as well as the individual's age, sex, and baseline severity of impairment 3, 6, 5.