454
Personalized Management of Traumatic Brain Injury
Molecular Basis of Management of Traumatic Brain Injury
There is considerable variation in the response of patients to traumatic brain injury
(TBI). Expression of some genes such as APOE have been implicated in outcome
following TBI, but extensive review of literature has revealed contradictory results
that are attributable to the heterogeneity of studies. Further research is needed to
assess the relationship between genetic traits and clinical outcome of TBI (Davidson
et al. 2014 ). Biomarkers are useful as diagnostic, prognostic, and monitoring
adjuncts. Changes in the expression profi le of biomarkers such as microRNAs in
peripheral blood mononuclear cells may refl ect molecular alterations following
brain injury that contribute to the sequelae (Pasinetti et al. 2010 ).
Mild hypothermia, used for neuroprotection following TBI has a signifi cant
effect on the gene expression profi les of the hippocampus (Feng et al. 2010 ).
Differential expression of these genes may be involved in the mechanisms of
neuroprotection.
Personalized Management of Sleep Disorders
Sleep is a complex phenomenon in which specifi c psychological, electrophysiologi-
cal, neurochemical, endocrinological, immunological and genetic factors are
involved. It is obvious that any set protocol of pharmacotherapy is not a satisfactory
approach to managing sleep disorders. Polysomnography is the gold standard of
sleep investigation, but brain imaging, neuroendocrine testing, DNA sequencing
and other laboratory measures can be useful for obtaining a biomarker profi le that
enable optimization of the effects of individualized therapies while minimizing
adverse effects of drugs used to modulate sleep (Dresler et al. 2014 ).
Personalized Therapy of Insomnia
The treatment of primary insomnia may be complex and clinically challenging.
A comprehensive multidimensional evaluation with a thorough history and physical
examination coupled with appropriate testing/imaging will facilitate development of
a working diagnosis. Optimal treatment strategies of challenging cases typically
involve interdisciplinary team approaches (including a sleep medicine specialist)
providing multimodal approaches to treatment, including nonpharmacological and
pharmacologic strategies. Treatment plans based on sound medical judgment, clini-
cal insight, and a thorough and global understanding of particular patient’s comorbid
conditions such as depression may lead to optimal patient-specifi c/patient-focused/
12 Personalized Management of Neurological Disorders