Severe Head Trauma and Omega-3 Fatty Acids

Abstract

Severe traumatic brain injury (TBI), with its diverse heterogeneity and prolonged secondary pathogenesis, remains a clinical challenge. Current medical management of TBI patients appropriately focuses on specialized prehospital care, intensive acute clinical care, and long-term rehabilitation but lacks clinically proven effective management with neuroprotective and neuroregenerative agents. Clinical studies thus far have failed to identify an effective treatment strategy as they typically have targeted single enzymatic factors in an attempt to identify a pharmacologic target rather than considering multiple mechanisms of injury with a more holistic approach. A combination of targets controlling aspects of neuroprotection, neuroinflammation, and regeneration is needed. Omega-3 fatty acids (o-3FA) offer the advantage of this poly-target approach. Although further clinical trial research is needed to establish the true advantage of using o-3FA, there is a growing body of strong preclinical evidence, and clinical experience suggests that benefits may be possible from aggressively adding substantial amounts of o-3FA to optimize the nutritional foundation of severe TBI patients. Administration of substantial and optimal doses of o-3FA early in the course of TBI, even in the prehospital or emergency department setting, has the potential to improve outcomes from this potentially devastating public health problem. With evidence of unsurpassed safety and tolerability, o-3FA should be considered mainstream, conventional medicine, if conventional medicine can overcome its inherent bias against nutritional, non-pharmacologic therapies.