Brain Damage, Brain Repair
Authors: Geoffrey Raisman
Journal: Journal of the Royal Society of Medicine (2003)

At the moment, damage to the brain and spinal cord, whether traumatic or a result of disease or degeneration, is largely irreparable. Numerous approaches to repair are being explored and the goal is becoming tantalizingly close, but success will depend on close collaboration between laboratory scientists and clinicians. Such collaboration is increasingly difficult to achieve: the burgeoning of detailed scientific knowledge, on the one hand, and clinical knowledge, on the other, means that few teams are able to bridge the gap. In the laboratory, animal and tissue culture models with highly controlled lesion technology generate the large numbers of treatment and control experiments needed to obtain consistency, and permit a vast range of tests, observations and histology. They allow rapid advance, but on a very narrow front. By contrast, clinical conditions are complex, exhibiting multiple and varying manifestations, with each individual having unique features. The more a clinical condition is investigated, the more variations are encountered, and no animal model can mimic the complexity and range of symptoms experienced by humans. The existence of a science-to-patient gap is thus hardly surprising. Now, Brain Damage, Brain Repair provides a source book for those who would venture to cross it.

Though the book is the work of many contributors, mainly Cambridge based, the chapters have been carefully assembled to produce a unified work. The first section deals with the complex array of cellular mechanisms involved in damage to brain and spinal cord (collectively referred to as the central nervous system, CNS). In general, these mechanisms are peculiar to the CNS, not found in other tissues of the body. They include the regulation of cell death, the effects of cutting axons, and demyelination. Metabolic forms of damage, the spread of infection and inflammation, and degenerative diseases also take forms unique to CNS tissue.

The second section considers methods for the limitation of damage, neuroprotection, the use of steroids and other anti-inflammatory agents, and the effects of various trophic factors. Allied to this is a third section outlining what is known about the intrinsic mechanisms for recovery by metabolic changes, sprouting, and relearning the use of surviving connections, and remyelination.

The next section takes up the clinical picture of brain and spinal cord damage in terms of motor, sensory and autonomic functions, as well as the assessment of the cognitive and psychiatric impairments that are encountered. The four chapters in this section clearly illustrate the large gap between what can be studied in animal experiments and the vast range of observations that can be made by clinicians examining patients. This is followed by an overview of what pharmacological and rehabilitative measures are currently available in practice for clinical treatments.

The chapters of the final section deal with the advancing edge of laboratory research. These include a resume of what is known about axon regeneration in the central and peripheral nervous system, the promising results seen with transplantation of nerve cells (e.g. in Parkinson's disease), and the transplantation of glial cells as a method for obtaining remyelination in demyelinating diseases or for providing a bridge to allow regenerating axons to re-establish functionally valuable connections. The growing fields of stem cell research and gene therapy are covered in brief chapters. For research students, many of whom enter this area without clinical training, there are very useful appendices offering two-page summaries of the main features of eight of the principal clinical conditions.

Brain Damage, Brain Repair is an excellent and authoritative source book on what, for most people, is the most important question about the nervous system—how to repair the damage inflicted by the ever more violent ways of peace and war and the depredations of age. Reading it, one is surprised that the need for such a work has not been recognized before.