Battling brain injuries
Female hormones put up fight against head trauma
BY KAVITA PILLAI Cox News Service
Robert Smith was driving to his Hiram, Ga., home in 2004 when his car flipped off a 13-foot embankment and wrapped around a tree.

ELISSA EUBANKS/COX NEWS SERVICE Brain injury survivor Marc Baskett was in a car accident in 2004 that left him almost brain dead. He credits an experimental clinical trial that used progesterone to treat brain injuries with his survival.

Smith, who was partially ejected, was unconscious when paramedics pulled him from the wreckage, and doctors would later tell his wife that the prognosis wasn't good - if he survived, he'd likely be in a vegetative state.

But after two months in a coma, Smith awoke in a darkened hospital room. Nurses found him sitting in a chair. He could walk; he could talk. He remembered everything except for the week leading up to the accident and the accident itself.

Smith, now a network engineer in Kings Bay, Ga., for the Atlantic division of the Strategic Weapons Facility, attributes his extraordinary recovery to an experimental treatment he received at Grady Memorial Hospital as part of a study by Emory University researchers.

Shortly after he arrived in the emergency room, he was given high doses of progesterone, commonly known as a female hormone - a label researchers say can be misleading.

"I believe that the progesterone is the reason I'm back doing computer work," he said. "I didn't have to relearn how to walk, how to talk."

The 42-year-old husband and father was one of 100 participants in a three-year study of the safety of using progesterone to treat brain injuries.

Four of every five patients older than 18 who came in with a moderate-to-severe blunt head injury were given the progesterone within 12 hours of their injuries. The other patients were given placebos.

The results, say project leader David Wright, were remarkable.

The research, published in the Annals of Emergency Medicine, showed a 50 percent reduction in the mortality rate for the severe traumatic brain injury group that took progesterone. Doctors use the Glasgow Coma Scale to rate the conscious state of a person, with 3 being the worst and 15 being the best.

Smith said he was rated a 3.

About 30 percent of placebo patients died within 30 days of their injury, while 13 percent of the progesterone group died.

For those with moderate brain injuries, Wright said the study showed less disability for those in the progesterone group. He added that the study's primary goal was to establish safety and that no adverse side effects were found.

Marc Baskett, 22, was another member of the progesterone group. He rated a 4 on the Glasgow scale after surviving a head-on collision on his way to a picnic in Helen, Ga., just three weeks before he was to graduate from high school.

"My parents thought I was going to be in a hospital for the rest of my life," said Baskett, who has had 16 surgeries for other injuries related to the 2004 accident.

"Now, I'm completely back mentally. I'm just waiting on the physical stuff."

Baskett, who lives in Commerce, Ga., received his diploma while hospitalized. He now works as a caregiver.

If further study yields similar results, the hormone could become a major treatment for injuries that affect 1.4 million people in this country each year, according to the U.S. Centers for Disease Control and Prevention. Battlefield implications are evident: Severe head trauma has become a common injury for U.S. soldiers.

The Emory team is now designing an expanded clinical trial with 1,000 patients in 15 hospitals across the country. If that project is approved by the Food and Drug Administration and goes as planned, the treatment could be widely available as soon as three years from now.

Signature injury of soldiers

With traumatic brain injuries the signature injury of the U.S. war in Iraq, Emory's researchers are hopeful that the progesterone study will lead to a viable treatment for victims of roadside bombs.

A 2003 survey of Walter Reed Army Medical Center patients back from Iraq showed 62 percent had sustained a brain injury.

Wright said the research team has had several discussions with the U.S. Department of Defense to inform them of the research.

He noted that no effective treatment for traumatic brain injuries exists, making its application to the military more profound.

"It's a horrible problem and you have nothing to treat these kids with," he said.

Wright said the military likely will wait until studies are complete before integrating the progesterone treatments.