Opiate antagonists and thyrotropin-releasing hormone. II. Potential role in the treatment of central nervous system injury

PARALYSIS resulting from CNS injury has been recognized for more than 2,000 years. Although much has been learned about the pathophysiology of spinal cord injury, head injury, and stroke, therapeutic management of such patients, particularly with regard to pharmacologic interventions, has progressed relatively little. This lack of progress has generated a sense of futility among physicians who treat these conditions. Yet a number of novel therapeutic measures have been suggested over the past few years, based on the successful alteration of neurological outcome following experimental CNS injury. Of particular interest have been the observations that opiate antagonists may improve neurological recovery in experimental stroke, head injury, and spinal cord injury and that thyrotropin-releasing hormone (TRH) may significantly enhance motor recovery after traumatic spinal cord injury. CNS Injury—Pathophysiological Considerations During the past decade it has become increasingly clear that traumatic or ischemic insults to the CNS may cause neurological deficits through