Clinical Strategies for Neuronal Protection
Cortical neurons are injured by acute insults, such as ischemia, trauma, and epilepsy, as well as by a variety of chronic neurodegenerative disorders. Although the events that initiate neuronal degeneration vary from disorder to disorder, the fundamental processes that ultimately cause neuronal death are remarkably similar. Over the past decade, major advances in molecular and cellular neurobiology have converged to outline a “final common pathway” of neuronal injury, which involves overactivation of excitatory amino acid receptors, excessive intracellular calcium fluxes, subsequent activation of catabolic enzymes, and production of free radicals. These processes are influenced by a variety of neurotransmitters, neuromodulators, alterations in gene expression, and growth factors. This chapter briefly reviews the scientific rationale behind two emerging neuroprotective strategies—excitatory amino acid antagonists and inhibitors of oxygen radical-mediated lipid peroxidation—and emphasizes the challenges involved in establishing the efficacy of these novel treatments in patients.
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