Journal of Neurology, Neurosurgery, and Psychiatry 2006;77:1105
EDITORIAL COMMENTARY
Head injury
Patients after a head injury face an uncertain long-term future
Correspondence to:
Correspondence to:
S Fleminger
Lishman Unit, Maudsley Hospital, London SE5 8AZ, UK;s.fleminger@iop.kcl.ac.uk
Long-term changes in patients after head injury: for better or for worse?
| The first 150 words of the full text of this article appear below. |
After a head injury, it is sometimes assumed that once the first 2–3 years of recovery have passed, any impairment and disability remaining is fairly fixed. There will be little further improvement and in the unlikely event of any subsequent deterioration, the clinician should expect to be able to find a specific cause—for example, hydrocephalus—for the decline. However, longer-term follow-up studies suggest that in fact a fair proportion of patients change, some for the better and some for the worse.
The last time the Journal considered this issue was in 2003.1 Millar et al2 found that at 18 years follow-up after a head injury, twice as many patients had deteriorated (32%) as improved (15%) compared with how they were 6 months after the injury. There was no evidence that a biological marker, APOE 
4 status, could predict who would deteriorate. Since then, another group from Glasgow, again using
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