Traumatic brain injury (TBI) affects 1.7 million people annually in the U.S. with 275,000 hospitalizations and 52,000 deaths. In 2010, the medical cost for treating TBI patients in the U.S. was $76.5 billion and rising annually. Primary causes for TBI include the following: motor vehicle crashes, falls, assaults and sports or recreation-related injuries (concussions). Finding the right treatment to reduce mortality rates and improve the clinical outcomes in TBI patients has been elusive.
Professor Leslie Mathews of Morehouse School of Medicine is a trauma surgeon who treats TBI patients. He and his colleagues have just published a case series of a new successful treatment of TBI.
Matthews LR, Danner OK, Ahmed YA, Dennis-Griggs DM, Frederick A, Clark C, Moore R, DuMornay W, Childs EW, Wilson KL. Combination therapy with vitamin d3, progesterone, omega 3-fatty acids and glutamine reverses coma and improves clinical outcomes in patients with severe traumatic brain injuries: A case series. International Journal of Case Reports and Images 2012;4(3):143–149.
Let’s simply quote his paper of the first case report for our physician readers. By the way, Glasgow Coma Scale (GCS) is a standardized test for brain injury, ranging from a score of one to fifteen with one being the worst and fifteen considered normal.
“Case 1: Patient 1 was a 17-year-old female restrained driver, who was involved in a single car, multiple rollover motor vehicle crash with a 10 foot ejection. She presented to the Emergency Department intubated and unresponsive with a GCS of five out of fifteen. Her physical exam was notable for a blood pressure of 105/56 mmHg, pulse of 87 beats/min, temperature of 37.7 C, respiratory rate of 20/min, and oxygen saturation of 100% on the ventilator. Her secondary survey revealed unequal pupils with discordant reactivity. Her right pupil was 8 mm and non-reactive to light and her left pupil was 3 mm and reactive to light. Ominously, she was noted to have decerebrate posturing (indicating severe brain damage) of both the upper and lower extremities bilaterally. On further examination, a five cm laceration to the right lower anterior thigh was identified and repaired. Her Focused Assessment Sonogram for Trauma (FAST) exam was negative.
The initial computed tomography (CT) scan of her head revealed multifocal, punctuate brain hemorrhages, consistent with a diffuse axonal injury (DAI). (Figure 1) CT scans of the cervical spine, chest, abdomen, and pelvis revealed bilateral spinous process fractures of C7, T1, and T2, a mid sternal body fracture, bilateral pulmonary contusions, and a distal right clavicle fracture. She also sustained a cardiac contusion associated post-injury arrhythmias, which were treated conservatively. An external ventricular drainage device was placed by neurosurgery to help monitor and manage her intracranial pressure and maintain her cerebral perfusion pressure within acceptable limits.
Upon her admission to the surgical intensive care unit (SICU), she was started on a regimen of vitamin D3, 50,000 IU, progesterone 20 mg, omega-3 fatty acids 2 grams (Loveza), and enteral glutamine 20 grams via her nasogastric tube (NGT) every day. Her decerebrate posturing resolved in less than 24 hours. By hospital day-3, she was able to follow simple commands while off sedation.
Her GCS and clinical status continued to improve and she was able to be extubated on hospital day-9. She was discharged to inpatient rehabilitation on hospital day-18. Although her GCS improved to 12 prior to rehab transfer, some residual right-sided weakness remained. She rapidly progressed to a GCS of 15 during her recovery and was discharged home from inpatient rehab doing well after one month. In less than three months after her initial insult, she has returned to school full time and is completing her senior year of high school with her right-sided weakness essentially resolved.”
Figure 1: Ct scan of 17 year old girl with traumatic brain injury.
The other case reports show equally amazing improvements. This work seems to show that Dr. Mathews’ treatment helps the brain repair itself. Notice he had no reservation about giving 50,000 IU/day for several weeks. 50,000 IU is actually only 1.25 mg, which doesn’t sound like so much. Though, one needs to be cautious when supplementing with daily dosages over 10,000 IU for long periods of time, this was not supplementing, this was treatment. Dr. Mathews emphasizes that all of the components of his treatment cocktail are important, not just the vitamin D.
The authors conclude:
“We have reported a case series of three patients with very severe TBI’s who were managed with vitamin D3, progesterone, omega-3 fatty acids, and glutamine. All three patients were presented in a coma, and had very poor and grave prognosis based on their CT scan and neurosurgical consultation/recommendations. They are now well adjusted and have returned to their mental baselines with minimal long-term affects of TBI, other than short-term memory loss, which is rapidly improving.
Our group is the first to report in literature the multi-component therapeutic regimen of vitamin D3, progesterone, omega-3 fatty acids, and glutamine as a combination therapy for moderate and severe traumatic brain injury treatment, which we have termed neuroceutical augmentation for TBI (NATBI). The potential for improving clinical outcomes and potentially decreasing healthcare costs associated with TBI patients is limitless. A large clinical study trial using these four supplements together is warranted.”