A search for articles related to TBI yields approximately 50,000 to 120,000 references, depending on the search terms. Combining these terms with “chronic” or “long-term” reduces the number by more than 90%. The results suggest that less than 10% of TBI research is related to chronic effects or long-term outcomes. Although research on the chronic consequences of neurotrauma is expensive and time-consuming, it is very important. Implicit in the nomenclature of TBI is the concept that trauma to the brain is the result of an injury and that the injury will heal. Injuries frequently have a proscribed protocol for treatment that may result in significant improvement and possibly a cure. This, however, is not always the case with TBI.
By its very nature, every TBI has its own unique multifaceted signature, which will manifest as one of a constellation of neurological effects. While many of the 1.5 million TBIs sustained annually in the United States are indeed injuries from which each patient recovers, more than 125,000 of these injuries are permanent and incurable. The articles presented in this special edition support the concept that many TBIs are chronic and that a TBI is the beginning of an evolving process of medical issues that negatively impact the lives of those affected. With its high prevalence, especially in the young, and its vast medical, psychological, and social consequences, a TBI carries incredibly high personal, economic, and social costs. As scientists and clinicians, our challenge is to look at TBI in an entirely different light. Researchers must focus beyond the first few precious hours during which the acute injury is negatively impacted by a toxic cascade of cellular events. The focus also needs to be on the mechanisms causing some persons to have a lifetime of “toxic” medical events from their TBI. With a better understanding of the issues that occur with a chronic TBI, perhaps some day there will be a special edition of the Journal of Neurotrauma devoted entirely to effective cures for TBIs.