Nervous system injury

The evidence here is mostly about prognosis and rehabilitation after a nervous system injury has already occurred, not about preventing one or choosing whether to accept a medical intervention.

The records cover spinal cord injury, traumatic brain injury, and stroke. For spinal cord injury, one study shows that about 5 in 100 people with a complete injury (AIS grade A) regain the ability to walk at one year, compared to about 69 in 100 with an incomplete injury (AIS grade C) [1]. For traumatic brain injury, a large study found that moderate-severe TBI roughly triples the risk of death compared to the general population for people aged 15 to 54 [4]. The strongest predictor of survival after severe TBI is keeping intracranial pressure below 20 mmHg: mortality was 47% above that threshold versus 17% below it [5].

On the treatment side, the evidence is thin and mostly from animal models or small human studies. One animal study found that the protein decorin reduced scarring in acute spinal cord wounds by 77% [2]. A meta-analysis of human trials found that therapeutic hypothermia can reduce mortality after severe TBI, but only when done with a high "cooling index" — milder temperatures, longer duration, and slow rewarming — and guided by intracranial pressure monitoring [6]. The effect was an odds ratio of about 0.53 when ICP-guided [6]. A systematic review found that drugs blocking the RhoA/ROCK pathway improved locomotor recovery after spinal cord injury by about 15% after adjusting for publication bias [3].

The most striking new finding is from a 2026 mouse study: peripheral nerve injury causes B cells to form organized immune clusters (tertiary lymphoid structures) in the membranes around the dorsal root ganglia. Disrupting these clusters — either by deleting a gene in germinal center B cells or by giving a single injection of a CD20 antibody — prevented the development of chronic neuropathic pain for at least four weeks [7]. This is a mechanism, not a proven human treatment, but it points toward a future therapy that targets the immune system rather than the nerve itself.

My call: for someone who already has a nervous system injury, the evidence supports early rehabilitation (starting within 20 days after stroke tripled the odds of excellent recovery [8]) and careful control of intracranial pressure after TBI. The experimental treatments (decorin, RhoA/ROCK blockers, hypothermia protocols, anti-BDNF antibodies) are not ready for routine use. The B-cell discovery is promising but still in mice. Confidence: moderate for the prognostic numbers and rehabilitation timing; low for any specific drug or biologic intervention.