ABSTRACT
Clinical trials for traumatic brain injury (TBI) have not successfully produced a new therapeutic for neuroprotection or neurorestoration, despite multiple attempts. Stem cell-based therapies and/or cellular therapies have been developed over the past 20 years such that clinical trials are now in Phase II and III stages for neurologic diseases such as TBI and stroke. Many of the vexing issues from past clinical failures still exist today, namely, preclinical data that may not translate to clinical trial because of design and injury heterogeneity that poorly stratifies enrolled patients. Recognition of these problems has led us to advocate for outcome measures that are clinically meaningful, but do not represent a global functional "score." Specifically, we seek to measure those early physiologically relevant outcomes (intracranial pressure, edema, and therapeutic intensity) and later structural outcomes in regions of interest that are linked to putative mechanisms of action of cell based therapies. Early approval of therapeutics that are successful by these metrics would then allow further access to treatments that could be further tested via patient registries and other surveillance for ultimate adoption. Continuing to do the same thing with each iterative trial will assure the same results.
Subject(s)
Brain Injuries, Traumatic/therapy , Cell- and Tissue-Based Therapy/methods , Brain Injuries, Traumatic/physiopathology , Clinical Trials as Topic , Humans , Intracranial Pressure/physiologyABSTRACT
The study investigates the relative degree and timing of cortical activation in parietal, temporal, and frontal regions during simple arithmetic tasks in children who experience math difficulties. Real-time brain activity was measured with magnetoencephalography during simple addition and numerosity judgments in students with math difficulties and average or above average reading skills (MD group, N = 14), students with below average scores on both math and basic reading tests (MD/RD group, N = 16) and students with above average scores on standardized math tests (control group, N = 25). Children with MD showed increased degree of neurophysiological activity in inferior and superior parietal regions in the right hemisphere compared to both controls and MD/RD students. Left hemisphere inferior parietal regions did not show the expected task-related changes and showed activity at a significant temporal delay. MD students also showed increased early engagement of prefrontal cortices. Taken together, these findings may indicate increased reliance on a network of right hemisphere parietal (and possibly frontal areas as well) for simple math calculations in students who experience math difficulties but perform within normal range in reading.
