For decades, corticosteroids have been used routinely throughout the world to treat head injuries. But recently, a major research project co-ordinated in South Africa for the British Medical Research Council (BMRC) by Professor Bennie Hartzenberg, head of neurosurgery for the Faculty of Health Sciences at Stellenbosh University, suggested otherwise.

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Previous studies suggested that corticosteroids, used as a rapid anti-inflammatory medication, could be given to patients who sustained head injury. It was thought that such treatment could reduce death by preventing brain swelling that occurs after a head injury. However, Hartzenberg says these previous studies have not provided enough evidence leading to the success of this treatment.

The BMRC Corticosteroid Randomisation after Significant Head Injury project (CRASH) was launched in 1999 to check the effectiveness of corticosteroids as an anti-inflammatory treatment. More than 200 hospitals in 49 countries took part in the study and involved some 10 000 patients.

Early results terminate project
During mid-2004, the data monitoring committee revealed premature results. The committee discovered that 21 percent of those who received corticosteroids, had died within two weeks of treatment. These results were made in comparison to those who received placebo treatment, where only 18 percent had died.

The project was then terminated earlier than expected and it was concluded by trial collaborators, that corticosteroids should not be used routinely to treat head injuries, no matter what the severity.

“The reason why the group of patients that were on corticosteroids did worse, is not known. The study did not set out to determine why they did worse, so we could not answer this. The area has not been researched as far as I know,” Hartzenberg said in an interview with Health24.

Routine use not recommended
At a conference hosted in Oxford, England earlier this year, Hartzenberg presented the CRASH results. These showed no evidence of improvement in patients after six months, when compared to their condition fourteen days after initial treatment. These results have had a great impact on trauma research, leading to improved patient care and the protection of thousands of patients from the increased risk of corticosteroids.

The Department of Neurosurgery at the Stellenbosch University has always suggested the potential dangers of excessive use of corticosteroids, but Hartzenberg is now satisfied that their view is supported by the CRASH study.

“The recovery times for patients with head injuries vary as a result of the severity of the injury. Some may never recover and may be permanently disabled. A minor concussive injury can take weeks to recover,” says Hartzenberg.

Currently, there is no suggested alternate drug that has been identified to improve the outcome of head injury. Many have been tried and several research programmes continue in First World countries.

Corticosteroids effective in other treatments
However, Hartzenberg stressed that the dangers of corticosteroids refer only to the treatment of head injuries, and not to the treatment of other conditions, where the results have been largely successful. He described how they are effectively used in order to prevent secondary injury in neurosurgical patients.

Globally, head injury is a large concern. The condition is very common, especially amongst the younger generation. Annually, large numbers die or are disabled by head injuries.

Corticosteroids act on the immune system by suppressing the production of substances that can cause inflammation or allergic reactions. However, they are also known to alter the function of white blood cells, therefore increasing the risk of infection. They are very strong medicines that can have serious side effects, if not used in the correct manner.

(Matthew Louw, Health24, November 2005)

(Source: Tygerland Magazine, October 2005)

For more information visit: Dementia SA: http://www.dementiasa.org/ or Alzheimer’s South Africa: http://www.alzheimers.org.za
 

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