Neuroprotective Treatment [Neurosurgery Wiki]

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====== Neuroprotective Treatment ======

Neuroprotective treatment includes therapeutic strategies aimed at preserving neuronal structure and function and preventing cell death in neurological diseases, trauma, or neurodegeneration.

===== 🧠 Key Concepts =====
  * **Goal:** Limit neuronal damage, promote recovery, and improve functional outcome.
  * **Critical timing:** Most effective when initiated early ("time is brain").
  * **Pathophysiological targets:** 
    * Oxidative stress
    * Excitotoxicity
    * Inflammation
    * Mitochondrial dysfunction
    * Apoptosis
    * Blood-brain barrier disruption

===== 🧪 Examples of Neuroprotective Treatments =====

==== ⚡ Pharmacological Agents ====
^ Class ^ Examples ^ Mechanism of Action ^
| NMDA receptor antagonists | Memantine, Ketamine | Block glutamate-induced excitotoxicity |
| Antioxidants | Edaravone, N-acetylcysteine | Reduce oxidative damage |
| Anti-inflammatory agents | Minocycline, Corticosteroids | Suppress microglial activation and cytokine release |
| Mitochondrial stabilizers | Coenzyme Q10, Creatine | Improve mitochondrial energy production |
| Calcium channel blockers | Nimodipine | Prevent intracellular calcium overload |
| Therapeutic hypothermia | Induced cooling | Decrease metabolism and inflammation |

==== 🌱 Experimental / Adjunctive Strategies ====
  * **Stem cell therapy** – Promotes regeneration and neurotrophic support
  * **Gene therapy** – Modulates gene expression toward neuroprotection
  * **Exosome or miRNA delivery** – Modifies intercellular signaling for survival
  * **Remote ischemic conditioning** – Activates endogenous protective pathways
  * **Preconditioning protocols** – Mild stress to build cellular resilience

===== 🧬 Neuroprotection by Disease Area =====

^ Disease ^ Neuroprotective Approach ^
| Stroke | rtPA + edaravone (in some countries), hypothermia (experimental) |
| Parkinson’s Disease | MAO-B inhibitors, CoQ10, experimental agents |
| Alzheimer’s Disease | Antioxidants, anti-amyloid drugs, lifestyle interventions |
| Traumatic Brain Injury | Hypothermia, neurohormonal therapies, early rehab |
| Multiple Sclerosis | Early disease-modifying therapies (DMTs) |
| Intracerebral Hemorrhage | Agents under research: deferoxamine, minocycline, [[miR-210]] |

===== 🚧 Challenges in Neuroprotection =====
  * Many compounds are effective in preclinical models but fail in clinical trials.
  * Need for better biomarkers, optimized timing, and personalized strategies.
  * Blood-brain barrier limits drug delivery to CNS.