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Targeted treatment in severe traumatic brain injury in the age of precision medicine

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Abstract

In recent years, much progress has been made in our understanding of traumatic brain injury (TBI). Clinical outcomes have progressively improved, but evidence-based guidelines for how we manage patients remain surprisingly weak. The problem is that the many interventions and strategies that have been investigated in randomized controlled trials have all disappointed. These include many concepts that had become standard care in TBI. And that is just for adult TBI; in children, the situation is even worse. Not only is pediatric care more difficult than adult care because physiological norms change with age, but also there is less evidence for clinical practice. In this article, we discuss the heterogeneity inherent in TBI and why so many clinical trials have failed. We submit that a key goal for the future is to appreciate important clinical differences between patients in their pathophysiology and their responses to treatment. The challenge that faces us is how to rationally apply therapies based on the specific needs of an individual patient. In doing so, we may be able to apply the principles of precision medicine approaches to the patients we treat.

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Authors and Affiliations

  1. Division of Neurosurgery and Neuroscience Institute, University of Cape Town, Cape Town, South Africa

    Anthony A. Figaji, A. Graham Fieggen & Ursula K Rohlwink

  2. Division of Neurosurgery, University of Cape Town, Cape Town, South Africa

    Ncedile Mankahla & Nico Enslin

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  1. Anthony A. Figaji
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Correspondence to Anthony A. Figaji.

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The authors do not have any conflicts of interest to declare. AF is supported by the National Research Foundation SARChI Chair of Clinical Neurosciences.

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Figaji, A.A., Graham Fieggen, A., Mankahla, N. et al. Targeted treatment in severe traumatic brain injury in the age of precision medicine. Childs Nerv Syst 33, 1651–1661 (2017). https://doi.org/10.1007/s00381-017-3562-3

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