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Traumatic Brain Injury: Current Treatment and Future Options
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Traumatic Brain Injury: Current Treatment and Future Options

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 20 January 2026 | Viewed by 3780

Special Issue Editor

Dr. Ismail Zaed

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Guest Editor
Department of Neurosurgery, Neurocenter of the Southern Switzerland, Ente Ospedaliero Cantonale, CH-2900 Lu-gano, Switzerland
Interests: neurosurgical anatomy; skull base surgery; endoscopic surgery; neuro-oncological surgery; neurovascular surgery; spine surgery; machine learning; enhanced recovery after surgery; global neurosurgery

Special Issue Information

Dear Colleagues,

Traumatic brain injury (TBI) presents a significant global health challenge; however, its critical aspects, such as a reliable pathophysiological classification and targeted treatments, still lack sufficient data. While there has been a surge in TBI-related publications, the translation of these research findings into clinical practice remains frustratingly slow.

Encouragingly, substantial international efforts offer hope for significant advancements in TBI diagnostics and patient care. Given its interdisciplinary nature, TBI spans multiple medical specialties, ranging from emergency medicine and intensive care to rehabilitation and psychiatry. Consequently, reports on scientific progress in this field are dispersed across various journals, each with its own narrow focus, complicating efforts to grasp the full scope of TBI medicine and emerging trends.

The rapid evolution of technical solutions in laboratory medicine, imaging, and neurophysiology has yielded new tools with numerous potential clinical applications. Few medical domains demand personalized medicine and the integration of artificial intelligence more than TBI, given its complexity as an individual disease. Despite the proliferation of innovative technologies and their potential applications, everyday TBI care has seen minimal progress over the past two decades and still heavily relies on the subjective experience and judgment of treating clinicians.

This Special Issue aims to provide an up-to-date review of TBI for all the healthcare professionals who meet and treat TBI patients at various levels and across different facilities. The focus of this Special Issue is on clinically relevant recent developments and emerging trends, with the aim of providing the reader with a good understanding of the current state of TBI medicine.

Dr. Ismail Zaed
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • traumatic brain injury
  • trauma
  • biomarkers
  • post-traumatic outcome
  • epidemiology

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Published Papers (4 papers)

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Research

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13 pages, 385 KiB  
Article
Glasgow Coma Scale Score at Admission in Traumatic Brain Injury Patients: A Multicenter Observational Analysis
by Iulia-Maria Vadan, Diana Grad, Stefan Strilciuc, Emanuel Stefanescu, Olivia Verisezan Rosu, Marcin Michalak, Alina Vasilica Blesneag and Dafin Muresanu
J. Clin. Med. 2025, 14(15), 5195; https://doi.org/10.3390/jcm14155195 - 22 Jul 2025
Viewed by 278
Abstract
Introduction: Traumatic brain injury (TBI) is a leading cause of morbidity worldwide, with the Glasgow Coma Scale (GCS) serving as a tool to measure injury severity. This study aimed to investigate the relationship between GCS admission scores and various socio-demographic, clinical, injury-related, and [...] Read more.
Introduction: Traumatic brain injury (TBI) is a leading cause of morbidity worldwide, with the Glasgow Coma Scale (GCS) serving as a tool to measure injury severity. This study aimed to investigate the relationship between GCS admission scores and various socio-demographic, clinical, injury-related, and hospital-related variables in patients with TBI across two tertiary care centers in Eastern Europe, a region that remains underrepresented in the literature. Methods: A retrospective observational study was conducted using data from 119 TBI patients admitted between March 2020 and June 2023 at Cluj County Emergency Hospital (Romania) and Saint Vincent Hospital (Poland). GCS scores were analyzed as both categorical and continuous variables. Statistical analyses included Wilcoxon and Kruskal–Wallis tests for group comparisons and Spearman correlations for continuous variables. Results: Most patients included suffered a mild TBI (GCS score between 13 and 15). There were significant associations between GCS scores and post-traumatic amnesia (p < 0.05), discharge status (p < 0.01), discharge destination (p < 0.01), and education level (p < 0.01). GCS scores at admission were linked to survival, absence of post-traumatic amnesia, higher education levels, and home discharge. No significant differences observed across sex, residence, employment status, injury type, cause, or mechanism of injury. A weak but significant negative correlation was observed between GCS and length of hospital stay (rho = −0.229, p > 0.05), while age showed a non-significant correlation. Conclusions: The GCS score at admission is significantly associated with various clinical and socio-demographic outcomes in TBI patients, supporting the utility of the GCS score as a prognostic tool. The predominance of mild cases and the absence of radiological data, such as cerebral contusions or epidural or subdural hematomas, limit the generalizability of the findings. Further studies with larger samples and comprehensive imaging data are necessary to validate these findings. Full article
(This article belongs to the Special Issue Traumatic Brain Injury: Current Treatment and Future Options)
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14 pages, 827 KiB  
Article
Clinical, Neuroimaging, and Genetic Markers Associated with Cognitive and Functional Outcomes After Traumatic Brain Injury
by Khrystyna Duve, Svitlana Shkrobot, Pavlo Petakh, Valentyn Oksenych and Oleksandr Kamyshnyi
J. Clin. Med. 2025, 14(8), 2796; https://doi.org/10.3390/jcm14082796 - 18 Apr 2025
Viewed by 572
Abstract
Background: Traumatic brain injury (TBI) is a major cause of long-term disability worldwide, often leading to progressive cognitive and functional impairments. This study aimed to investigate the underlying factors contributing to long-term deterioration in TBI patients. Methods: We conducted a comprehensive [...] Read more.
Background: Traumatic brain injury (TBI) is a major cause of long-term disability worldwide, often leading to progressive cognitive and functional impairments. This study aimed to investigate the underlying factors contributing to long-term deterioration in TBI patients. Methods: We conducted a comprehensive evaluation of 145 patients aged 18–66 years with a documented history of TBI and ongoing cognitive and behavioral deficits. Assessments included neuroimaging, laboratory tests, genetic analysis, and standardized tools such as the Montreal Cognitive Assessment (MoCA) and the Barthel Index. Results: Structural brain abnormalities, including ventricular enlargement and gliosis, were observed in a substantial portion of the cohort. Persistent neuroinflammatory markers were also identified. Genetic analysis revealed a significant association between cognitive decline and polymorphisms in the ACE and PON1 genes. Patients carrying these variants were more likely to exhibit reduced cognitive performance and greater functional limitations. Conclusion: These findings suggest that genetic predisposition, chronic neuroinflammation, and structural brain damage collectively contribute to long-term outcomes following TBI. This highlights the potential of genetic and imaging biomarkers in identifying high-risk individuals and supports the need for personalized approaches to diagnosis, monitoring, and treatment in chronic TBI management. Full article
(This article belongs to the Special Issue Traumatic Brain Injury: Current Treatment and Future Options)
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23 pages, 1203 KiB  
Article
Balance Performance After Mild Traumatic Brain Injury in Children and Adolescents: Instrumented BESS in the Acute Situation and Over Time
by Nils K. T. Schönberg, Johanna Wagner, Korbinian Heinrich, Ida Kandler, Tobias Graf, Rieke Böddeker, Lea Zinke, Nicole Fabri, Julia Wilke, Florian Hoffmann, A. Sebastian Schröder, Anne-Sophie Holler, Alexandra Fröba-Pohl, Oliver Muensterer, Doreen Huppert, Matthias Hösl, Florian Heinen and Michaela V. Bonfert
J. Clin. Med. 2025, 14(5), 1666; https://doi.org/10.3390/jcm14051666 - 28 Feb 2025
Viewed by 1009
Abstract
Background: Mild traumatic brain injury (mTBI) in the pediatric population is a significant public health concern, often associated with persistent post-concussion symptoms, including postural instability. Current tools for assessing postural control, such as the Balance Error Scoring System (BESS), lack integration with [...] Read more.
Background: Mild traumatic brain injury (mTBI) in the pediatric population is a significant public health concern, often associated with persistent post-concussion symptoms, including postural instability. Current tools for assessing postural control, such as the Balance Error Scoring System (BESS), lack integration with objective metrics. Incorporating force plate sensors into BESS assessments may enhance diagnostic accuracy and support return-to-play or sports decisions. This study evaluates postural performance in children with mTBI compared to controls using an instrumented BESS and examines recovery trajectories after mTBI. Methods: This prospective, longitudinal study included 31 children with mTBI (12.01 ± 3.28 years, 20 females) and 31 controls (12.31 ± 3.27 years, 18 females). Postural control was assessed using an instrumented BESS protocol during standing on a ground reaction force plate at three timepoints: within 72 h post injury (T1), at two weeks (T2), and three months after trauma (T3). Posturographic parameters derived from the displacement of the center of pressure included the ellipse area, path length, and mean velocity in the anterior–posterior and medio–lateral directions. Symptom burden was monitored using the Post-Concussion Symptom Inventory (PCSI). Results: The BESS total scores did not differ significantly between the groups at any timepoint. A significant reduction in BESS errors over time was observed exclusively in the two-legged stance on a soft surface (p = 0.047). The instrumented BESS revealed higher body swaying in the mTBI group compared to controls, particularly under demanding conditions. Significant between-group differences were most frequently observed in single-leg soft surface (38% of comparisons) and two-legged soft surface stances (29%). In those cases, path length and mean velocity differed between groups, respectively. Ellipse area did not show significant differences across conditions. Conclusions: An instrumented BESS has the potential to enhance the detection of subtle postural deficits in pediatric mTBI patients. Specifically, more demanding conditions with altered sensory-proprioceptive input and path length as an outcome measure should be focused on. This study underscores the need for tailored and age-appropriate objective and quantitative balance assessments to improve diagnostic precision in pediatric mTBI populations. Full article
(This article belongs to the Special Issue Traumatic Brain Injury: Current Treatment and Future Options)
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Review

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13 pages, 1051 KiB  
Review
The Brain Fatigue Syndrome—Symptoms, Probable Definition, and Pathophysiological Mechanisms
by Birgitta Johansson and Lars Rönnbäck
J. Clin. Med. 2025, 14(10), 3271; https://doi.org/10.3390/jcm14103271 - 8 May 2025
Viewed by 1292
Abstract
Fatigue is a common consequence of traumatic brain injury, neurological diseases or developmental disorders, and systemic inflammatory diseases, including autoimmune conditions that affect the brain. This condition is characterized by reduced endurance for cognitive tasks, diminished quality of life, and impaired work capacity. [...] Read more.
Fatigue is a common consequence of traumatic brain injury, neurological diseases or developmental disorders, and systemic inflammatory diseases, including autoimmune conditions that affect the brain. This condition is characterized by reduced endurance for cognitive tasks, diminished quality of life, and impaired work capacity. In addition to cognitive difficulties, individuals often experience disproportionately long recovery times after demanding tasks, emotional instability, stress sensitivity, sensory sensitivity, impaired ability to initiate activities, and sleep disturbances. Tension headaches frequently occur when the brain is excessively activated by mental activity. In this paper, we propose the term “Brain Fatigue Syndrome” (BFS) as a collective name for the symptoms closely associated with this pathological fatigue resulting from brain impact. BFS can be identified through interviews and measured using the self-assessment instrument, the Mental Fatigue Scale (MFS). We suggest potential underlying mechanisms at the cellular level for the BFS symptom complex, including astrocyte dysfunction with impaired glutamate signaling and glucose uptake, mitochondrial dysfunction, blood–brain barrier dysfunction, and the activation of microglia and mast cells. In conclusion, BFS suggests a general brain impact. The symptoms associated with BFS typically resolve when the injury or disease heals. However, in some individuals, BFS persists even after the injury or illness has ostensibly healed. Full article
(This article belongs to the Special Issue Traumatic Brain Injury: Current Treatment and Future Options)
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