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Progesterone Minimizes Brain Injury
> 5/5/2008 3:19:41 PM

The brain has an extraordinary ability to recover from damage, but just as skin sometimes scars when it closes a wound, mental scars sometimes remain years after a patient recovers from a traumatic brain injury (TBI). Our bodies do have some natural ways to minimize brain injury - triggering a coma or reducing our movement with a warning headache - but these protections are often unable to prevent permanent damage. A new study by Dr. Guomin Xiao, published last week in Critical Care, suggests that doctors may be able to prescribe a protective medication rather than just order bed-rest and anxiously test for damage.

Dr. Xiao's work builds upon previous evidence that neurons can be protected with the hormone progesterone. While progesterone is most commonly known for its role in birth control medication, it has also displayed neuroprotective qualities in laboratory cultures and in a variety of animals. In April of last year, a team led by Dr. David Wright conducted the first human study of progesterone injections and found that it decreased 30-day mortality rates from TBIs. There was some evidence from that study that progesterone also aided cognitive recovery, but this was limited by the short duration of the study.

This more recent study followed 159 patients from the moment they came into his teaching hospital to 6 months after the start of treatment. Within 8 hours of head injury, the control group was given a placebo, while the experimental group began receiving a twice-daily regimen of progesterone injections. Once again, the progesterone group was more likely to survive than the placebo group, but the more interesting finding appeared when subjects had their recovery tracked for six months on the Glasgow Outcome Scale, which measures symptoms from 1-15, 1 being total loss of function. 58% of the progesterone group had a favorable outcome, as opposed to 42% of the placebo.

The mechanism by which progesterone aids recovery is still a mystery, but we can see one hint in the fact that recovery benefit was almost entirely focused in one group of patients, those with healthier scores (in the range of 6 to 8). This may indicate that while the most acute trauma immediately kills neurons, less severe trauma endangers their health but offers a limited window in which they can be saved.

If further experimentation proves fruitful, there are many situations in which progesterone could save a mind. In circumstances where the risk of TBI is high, such as in a boxing ring or theater of war, doctors can be at the ready to deliver timely injections. None of the progesterone studies to date have found deleterious side-effects, and it is better to take precautions than to assume that impairment will go away with old-fashioned rest.

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