Pharmacotherapy in Traumatic Brain Injury. Where we are? Where we are going? However, when?

Traumatic brain injury (TBI) is an increasingly prevalent and complex challenge for society. Primary injuries are defined as those that occur at the moment of impact. Secondary injuries are those that occur after the initial injury as a consequence of physiologic / pathologic response to injury. This triggers a cascade of pathophysiological events that can extend over a long period of time. Whereas the primary injuries are considered irreversible, secondary injuries are potentially preventable with efficient triage and stabilization, management of parameters such as brain oxygenation, intracranial pressure, and cerebral perfusion pressure. Indeed, TBI should be thought of not as a static event, but rather a progressive injury with varying therapeutic windows. In this context the development of pharmacological treatment of patients with traumatic brain injury is urgent. In this review the authors describe the main drugs that are being studied in TBI patients. We conclude, despite substantial and ongoing investments in both phase I and II studies, there remain significant gaps in knowledge and faster translation to phase III clinical studies is mandatory.