Detailed Biography:

With approximately half a million serious head injuries occurring annually in this country, the recent failure of numerous therapeutic clinical trials has been truly disappointing. This lack of efficacy does not appear to be related to inadequate basic scientific effort but instead may reflect the difficult challenge in gaining a complete understanding of the complex injury-induced sequelae that follow human and experimental brain injury. Because of this deficiency in our basic concepts of head injury, the goal of the UCLA Brain Injury Research Center is to gain a more accurate understanding of the pathophysiological consequences of this process. Through parallel and complimentary studies in both animals and man, this objective is being pursued with a focus on post-traumatic metabolic dysfunction. It is postulated that a critical factor in determining long-term recovery of neurological function after head injury is the severity and duration of this dysfunctional metabolic state. Ultimately, it is hoped that our efforts to further understand post-traumatic metabolic changes will provide a sound conceptual basis from which novel therapeutic strategies can be rationally and effectively implemented in the future.

Patient Care

Clinical services include emergency evaluation and resuscitation, surgical treatment, and state-of-the-art neuro-intensive care management, facilitated by a dedicated neurosurgical ICU. In patients with post-traumatic cognitive and behavioral deficits, comprehensive and long-term care is coordinated with the UCLA Rehabilitation services and with the Daniel Freeman Rehabilitation Hospital.

Clinical Research

Through a multidisciplinary approach involving the Division of Neurosurgery and the Departments of Epidemiology, Neuropsychology, and Molecular and Medical Pharmacology, investigations are being conducted on all moderate and severe head injured patients admitted to the UCLA and Harbor-UCLA Medical Centers. The major focus of these studies is on gaining a clearer understanding of changes in cerebral blood flow and metabolism which occur after injury. The modalities employed include positron emission tomography to measure regional brain metabolism and blood flow, Xenon cerebral blood flow measures and transcranial Doppler ultrasonography to assess global changes in blood flow, jugular vein catheterization for analyzing cerebral levels of oxygen, glucose, and lactate and the use of microdialysis to measure local changes in brain biochemistry. Prospective data collection is ongoing, using all of these techniques throughout the acute postinjury period. Additional information on basic physiologic parameters, including intracranial pressure, blood pressure, computed tomography, EEG, as well as patient demographic information and long-term neuropsychological status are also documented. Over the last five years these efforts have begun to yield important new insights into the basic pathophysiology of human head injury and its ultimate impact on neurological outcome.

Basic Research

In concert with these clinical investigations, the UCLA Brain Injury Laboratory is further characterizing post-traumatic metabolic dysfunction and its relationship to recovery of function on a more fundamental level. In recent years, these efforts have yielded critical information on the neurochemical and metabolic alterations which occur from the moment of insult in both adult and developing animals. Perhaps most importantly, these investigations have demonstrated that the initial traumatic impact often does not result in irreversible neuronal damage. However, cells which do survive the primary mechanical injury are exposed to a neurochemical and metabolic cascade which render them extremely vulnerable to secondary insults. In addition to jeopardizing neuronal viability, this cascadecompromises the extent to which cells can exhibit functional plasticity, and may thereby preclude full recovery. Behavioral studies addressing the rate and/or extent of this recovery process span multiple modalities, ranging from sensorimotor functions to cognition, and are being directly correlated with biochemical markers of secondary injury.

Overall, the greatest strength of the UCLA Brain Injury Research Center is its multidisciplinary approach aimed at gaining a more complete understanding of the pathophysiology of traumatic brain injury. By bridging the basic-clinical science gap, we hope these efforts will provide the foundation for new and effective treatments which significantly enhance recovery of function.