NFL heroes like Brett Favre and Tua Tagovailova are proof we need to do more about Brain Injuries

Legendary NFL quarterback Brett Favre revealed he received a diagnosis of Parkinson’s disease inJanuary. According to Favre, five specialists have told him that his Parkinson’s probably resulted from the hits he sustained in his 20 years in the NFL. Favre, who has been outspoken about his history of concussions, believes he sustained not dozens or hundreds, but likely thousands of concussions during his career.

In recent years, we’ve come to understand the toll brain injury takes on athletes playing contact sports. Studies of the brains of deceased former NFLers have shown a strong link between repeated hits to the head and CTE, a progressive brain disease. Studies have similarly identified a connection between traumatic brain injury and Parkinson’s disease.

Changes have been made by the NFL in rules, protocol and helmets. The result: we have made the game safer but have not and will never eliminate concussions, repeated brain injuries, and their aftermath.

The concussion epidemic and repeated head impacts are rightly getting much more attention, but more needs to be done. We need to continue to advance our understanding of the brain and the link between head impacts and neurodegenerative diseases so we can develop effective treatments. While we watch and sympathize as former football players and other athletes struggle with dementia, Parkinson’s, ALS, depression and suicidal thoughts, it becomes clearer and clearer, that we need to find therapeutic approaches to treat the underlying damage from a traumatic brain injury. We need greater private investment in research and development of effective treatments. The Federal Government must increase funding to credible companies conducting research and development in this field.

Science is our only real solution to turning the corner on our understanding and successful treatment of brain injuries and neurodegenerative diseases. We see our NFL heroes like Brett Favre in the past and Tua Tagovailoa in the present suffer from injuries sustained on the field and it makes headline news. We need to protect those players or America’s love affair with football could be in jeopardy. We also must find a treatment to protect all Americans who suffer brain injuries – not just those on the playing field, but also those on the battlefield, on the road and in our own homes.

Michael Wyand, DVM, PhD, is CEO of Oxeia Biopharmaceuticals. Oxeia is conducting Phase 2 human clinical studies for its therapeutic drug, OXE 103, to treat concussions.

Chris Nowinski, PhD, is cofounder and CEO of the Concussion Legacy Foundation, cofounder of the Veterans Affairs-Boston University-CLF Brain Bank and an advisor to Oxeia Biopharmaceuticals. A former AllIvy defensive tackle for Harvard University and WWE professional wrestler, he suffers from PCS symptoms 16 years later.

The Pentagon Knows It Has a Problem with Veterans with TBI. New Data Shows its Extent.

Over a 15-year period, from 2006 – 2020, veterans with Traumatic Brain Injury (TBI) had suicide rates 56 percent higher than veterans without TBI and three times higher than the US adult population.  This staggering statistic was published last month in JAMA Neurology. 

The suffering of our veterans who are in such great pain with TBI is tragic.  Imagine the scores of brave men and women who served their country but are now hurt so badly that suicide is their only escape from immense pain.

The US Department of Defense (DoD) is aware of its TBI problem.  They have identified TBI as “one of the invisible wounds of war and one of the signature injuries of troops wounded in Afghanistan and Iraq.” The Pentagon is taking concussions seriously by helping to educate veterans and through work with the Defense Advanced Research Projects Agency (DARPA) to develop implants to help with TBI memory loss.  However, as Frank Larkin, chair of Warrior Call, points out in Military Times, “The Pentagon’s blueprint for curtailing military suicides … is noteworthy for what it lacks –– scant if any reference to preventing, better diagnosing and treating traumatic brain injuries …”

The statistics on veteran suicides should be setting off more alarms at DOD.  Such high suicide rates scream out the need to move with great urgency to not only prevent TBIs but also to improve long-term outcomes that ease the suffering of our soldiers and veterans with these conditions. 

Oxeia is looking to work with the federal government and the military establishment to advance the study of treatment for TBI that will benefit not only our wounded warriors but also the greater population.  We have been bringing our case to Capitol Hill over the past couple of years and believe we are inching closer to finding an effective cure for mild TBI.

We applaud the work the DoD is doing to ease the pain of our veterans.  Oxeia would like more to be done to bring service men and women the relief they need.  The treatment for TBI may just be at our doorstep.

One Million Americans go to Emergency Rooms after Falls each Year:Keep that in Mind on September 22nd and Everyday

September 22, 2023 is Fall Prevention Awareness Day.  We don’t expect big festivities for this occasion, but we hope maybe some Americans will take the time to think about the dangers of a most common problem: falling.

Oxeia takes fall prevention awareness seriously.   Falls are the most common cause of concussions. 

Brain injuries that are the result of spectacular tackles, jabs, or body checks generate the greatest news interest.  But athletes are not the only people getting concussions.  We are aware of the power sports have on concussion awareness.  After all, Oxeia has Alex Smith on its board of directors and Richard Sherman on our board of advisors.  Ultimately, we know that our dedication to finding a treatment for concussions is of importance to a far greater number of people who slip or fall in the kitchen, bathroom, or on the worksite floor than meet an unexpected fate at the hands of a tight end.

Here are some facts about falls to warrant your interest:

• One million seek emergency room treatment for falls; that translates to 2,000 ER-worthy falls per day in the USA alone. And the number of unreported concussions from falls is likely at least double that number.

• Slips and falls account for one-eighth of 8 million injuries and deaths each year in the USA.

• Slips and falls are the primary cause of occupational injuries for folks over age 55.

• According to a Centers for Disease report issued earlier this month, the leading cause of injury and death among adults aged 65 and older is unintentional falls.

Many falls may be destined to happen, but the truth is that many can easily be avoided.  The easiest thing you can do, simply put, is to be mindful of where you are walking.  Think about the kind of surface you are walking on.  Wet and uneven surfaces are dangerous.  Look out for parking lot potholes and torn carpeting.  And mind your footwear!  24% of falls occur when people wear improper shoes.  Sure 6-inch heels are a problem, but also be aware of any footwear lacking traction.

We Need More Than Awareness of Concussions, We Need a Cure

September 15th is National Concussion Awareness Day.  Awareness of concussions (also known as mTBI or mild traumatic brain injury) and their potential for long-term consequences has heightened over the past decade.  Much of this is thanks to the media coverage about concussions from sports; falls, military blasts, workplace accidents, domestic violence, as well as motor vehicle, bicycle, and e-scooter crashes.  Yet despite this increased understanding of the potential for long-term and often debilitating effects of concussions, we have made remarkably little progress in finding effective treatments. 

An estimated 7 to 21 million reported and unreported people sustain concussions a year in the U.S. Twenty percent of these – or 1.4 to 4.2 million – have ongoing post-concussion symptoms for months and years following their injury.  These debilitating symptoms require ongoing physical, speech, cognitive, vision, occupational and/or drug therapies.   Studies have also linked mTBI with depression and PTSD, and repeated mTBIs with various neurodegenerative diseases.  For example, studies have shown that veterans with a history of mTBI have a 56% higher risk of developing Parkinson's disease within 12 years of their injury,

Concussion awareness is essential to preventing concussions,  recognizing and reporting a concussion and getting medical care. But since we’ll never be able to eliminate concussions, we need more than that. The tangible and intangible costs to patients, their families and the larger community are significant.  The American Association of Neurological Surgeons puts annual direct and indirect costs of the full spectrum of TBIs – from mild to severe – are $76.5 billion.  Approximately 75% of all TBIs are mTBI. 

To date, the U.S. Food and Drug Administration has not approved any drug that is specifically indicated for concussions. However, several companies, including our company, Oxeia Biopharmaceuticals, are actively developing and testing new drugs to treat this devastating indication.  Small bioiopharmaceutical companies like ours need funding to advance research so we can develop treatments not only for a concussion’s immediate symptoms, but for the underlying damage.  Perhaps those with a vested interest in finding a cure, such as sports organizations, the media, the military and others should step up to the plate to help accelerate efforts toward finding an effective therapeutic for this unmet medical need. Rest is not enough. 

CONVENIENT, ECO-FRIENDLY AND COST-EFFECTIVE MICROMOBILITY ALTERNATIVES TO GASOLINE POWERED CARS RESULTING IN MORE HEAD INJURIES

In a recent article in Forbes , Tanya Mohn reported that the risk of head injury in a crash is high for e-scooter riders. According to the  research by the Germany-based, DEKRA the risk of concussion was nearly 100%.  A 2021 study conducted by the University Hospital Zurich and St. George’s University School of Medicine, Granada, compared injuries among bicycle, e-bike and motorcycle accidents. This research found that injuries were more frequent in e-bike a (66%) and bicycle accidents (64%) than motorcycle accidents (47%). (Other types of injuries were more frequent for motorcyclists.)

A U.S. Consumer Product Safety Commission report showed a 127 percent increase in electric micromobility devices from 2017-2021.  While they provide convenient, eco-friendly and cost-effective alternatives to gasoline powered cars,  the expected explosive growth products such as e-scooters and e-bikes, will also bring increasing numbers of head injuries.  The CPSC offers safety tips for people riding e-scooters, e-bikes and hoverboards:

• Always wear a bicycle helmet. 

• Before riding, make sure to check for any damage, which includes examining the handlebars, brakes, throttle, bell, lights, tires, cables and frame. 

• See and be seen. Most deaths involve motor vehicles. Many micromobility products are small, quick, and silent, making it difficult for others to spot you, especially in parking lots and structures. 

• Expect vehicle drivers and pedestrians not to see you; slow down and stay aware of your surroundings.

• Use the bell/horn to alert others. 

• Do not make abrupt, unpredictable movements. 

• Beware of obstacles. E-scooters have small tires, so objects and uneven surfaces can cause them to stop suddenly, throwing you off. 

• Always keep both hands on the handlebars and keep items off the handlebars.

• Slow down and lean back when you have to ride over bumps.

• Never ride under the influence of alcohol or drugs.

• Only one person per e-scooter; additional riders can increase the risk and severity of collisions.

• Follow all manufacturer directions, review the safety information and identify and weight and age limits for the micromobility product.

You can find more safety information at the Consumer Safety Commission website: https://www.cpsc.gov/Safety-Education/Safety-Education-Centers/Micromobility-Information-Center

Here at Oxeia Biopharmaceuticals, we are developing new, innovative therapeutics for mild traumatic brain injury (mTBI), known as concussion. Our aspiration at Oxeia is for people to stay safe and take steps to avoid concussions in their everyday lives, and to bring relief to those who have sustained a concussion. 

Preventing Workplace Concussions: Good for Employees and Employers

You’re probably not likely to get a concussion while working a desk job.  There could be a falling box incident or a slip in the break room on somebody’s spilt coffee event, but you aren’t likely to fret over the possibility of a brain injury in the safety of your cubicle.  Your chances of head injury, however, do increase if you work a more physical job, like on a construction site or in a factory.  Overall, reports of at-work concussions are nowhere near the number of concussions sustained by professional football players or slip-and-fall senior citizens, but that doesn't mean we should ignore them. 

While we may be pleased to hear that 91 percent of workers return to their jobs within 90 days of their accidents, there is still 9 percent of our workforce missing for an extended period and among the 91 percent of returnees, many of them may still be experiencing concussion symptoms. Workplace USA is not suffering as greatly from a concussion epidemic as the NFL is, but there are still many concerns about how head injuries at work are addressed.  Any employees missing from their jobs, possibly out on workmen’s comp, represent a cost to a company’s bottom line and having staff who come to work with a perpetual headache or other ongoing post-concussion symptoms isn’t good for employees, their families or employers either.

Safe + Sound Week 2023 is upon us (August 7 – 13), a nationwide event that recognizes the success of workplace health and safety programs and offers information and ideas on how to keep American workers safe.  There are many kinds of workplace safety issues that deserve attention.  As an employer look at your workplace and listen to your employees’ suggestions to take steps to safeguard your workers from concussions.

In a recent study, only one in ten working patients seen with concussions in the emergency room were injured at work.  According to the U.S. Centers for Disease Control and Prevention, almost three million patients with suspected brain injury visit the emergency room every year in the U.S.

Other studies indicate an even bigger problem with estimates of five million patients visiting emergency departments (ED) every year to be evaluated for a head injury. Approximately one-half are diagnosed with a TBI and as many as 95% of those with suspected TBI have mild TBI.  This translates into 142,000-237,500 people with workplace concussions visiting the emergency room yearly.  However, considering that an estimated five in 10 concussions go unreported, the number of workplace concussions is likely significantly higher.  

We should consider what we can do to decrease this number.  Supervisors, building managers and employees can help reduce the risk of falls, falling objects and bumps to the head by:

• Providing protective equipment (PPE) in situations where warranted, like warehouses and factory floors.  Make sure PPE is used and not sitting idly on the sidelines.

• Remove tripping hazards and make sure walkways and workspaces are free of clutter, cords, puddles – or anything that can cause a slip, trip or fall.

• Conduct regular inspections of the facility with an emphasis on walking and working surfaces.

• Improve signage to alert employees of wet or slippery surfaces and low overhands or limited overhead clearance.

• Clean and organize shelves and storage area spaces to avoid falling objects.

• Don’t stand on desks or chairs, get a ladder instead.

Learn more about Safe + Sound Week and developing or improving your company’s workplace safety at : https://www.osha.gov/safeandsound/safety-and-health-programs

Watch for Concussions In Water Sports

The warm weather is here and many of us head to outdoor pools, the beach, lakes, swimming holes and rivers for summertime fun.  We hear a lot about concussions in contact sports, but not so much about water sports such as tubing, surfing, jet skiing, wake boarding, water skiing, white water rafting and, even, swimming.  Yet emergency departments see a lot of head injuries from water sports every year. 

When a water skier hits the water at high speeds from a fast-moving boat, the water is like concrete.  A jolt to the head can occur when being pulled behind a boat on a board or inner tube in choppy water can cause a concussion.  While swimming isn’t supposed to be a contact sport, accidental contact with other swimmers, hitting one’s head when diving, diving incorrectly and hitting the pool wall can and frequently do result in concussions.

Since one doesn’t have to hit his or her head or be knocked unconscious to have a concussion, it’s important to be able to recognize the symptoms.  Concussion symptoms include chronic headaches, depression, problems with thinking and memory, vision and balance issues, and sleep disorders.[1]  Sometimes the person cannot recognize the symptoms him or herself, do not want to admit to the symptoms and/or don’t want to stop the sport or activity. As many as five in ten concussions in sports go unreported or undetected.[2]  This means that friends, coaches and others often need to be the ones to recognize the symptoms and seek medical attention for the person with a suspected concussion.

The Mayo Clinic provides a list of physical signs and symptoms to watch for at: https://www.mayoclinic.org/diseases-conditions/concussion/symptoms-causes/syc-20355594

Here at Oxeia Biopharmaceuticals, we are developing new, innovative therapeutics for mild traumatic brain injury (mTBI), known as concussion. Our aspiration at Oxeia is for people to stay safe and take steps to avoid concussions in their everyday lives, and to bring relief to those who have sustained a concussion. 

[1] https://www.mayoclinic.org/diseases-conditions/concussion/symptoms-causes/syc-20355594

[2] UPMC  Sports Medicine.

Study Shows That Cumulative Force of Head Impacts are the Best Predictors of CTE

In a recent study, researchers at Harvard Medical School and Boston University’s Chronic Traumatic Encephalopathy Center examined the causes and severity of CTE in football players and found that the number of and the cumulative force of head impacts are the best predictors of CTE.  This study, which looked at 631 brains, found that 71 percent had CTE.  The football players that were considered to have experienced the greatest cumulative force of head impacts were shown to have the worst forms of CTE. 

While diagnosed concussions on their own weren’t associated with increased CTE risk, they continue to be a silent epidemic in this country and abroad.  An estimated 69 million people sustain a traumatic brain injury (TBI) from all causes every year worldwide.  The greatest incidence per 100,000 people occurs in North America (1299 per 100,000 people).[1]  Concussions are the most frequent TBI.  

Concussions are caused by a direct or indirect blow, bump or jolt to the head. This sudden movement can cause the brain to bounce around inside the skull, which can result in chemical changes in the brain and sometimes stretching and other damage to brain cells. 

Concussion symptoms include chronic headaches, depression, problems with thinking and memory, vision and balance issues, and sleep disorders. Symptoms can be debilitating and can persist for days to months or even years, affecting personal, work and school lives. Up to one third of patients do not fully recovery from their concussions.

The Harvard-Boston University study raises awareness of the critical need for continued steps to reduce the risk in football and other contact sports.  However, no matter how safe we make sports, head impacts won’t be entirely eliminated for our athletes. Similarly, our servicemen and women, the elderly, traffic accident and abuse victims and others will continue to sustain head injuries.  CTE and debilitating post-concussion symptoms will continue to cause severe impairment and suffering long after sustaining the injuries unless we find effective treatments.

At the same time that we are reducing the risk of head traumas, we must also double down on our efforts to find potential treatments.

[1]  https://pubmed.ncbi.nlm.nih.gov/29701556/

The High Incidence of Concussions Among Seniors is Reason for Concern, but New Treatments May Be on the Way

The leading cause of injury for older adults is falling, with over 1 in 4 older adults reporting a fall each year, according to the Centers for Disease Control. The elderly also suffer concussions at far higher rates than any other group; falls are the primary cause.  

While concussions in seniors have a greater impact and result in more serious symptoms,   there is  some positive news about concussions. In a handful of laboratories around the country, scientists are developing and testing medicines to help repair brain damage from concussions, whether because of falls, other kinds of accidents or on the sports field.

A concussion, also known as a mild traumatic brain injury (mTBI) is caused by a direct or indirect blow to the head that disrupts the normal function of the brain. Symptoms of a concussion include headaches, nausea, sensitivity to light and sound, memory problems and depression.  While most people recover from concussions within a few weeks, some 20 to 30%  will experience ongoing symptoms lasting months to years after injury.

There are over three million hospital emergency room visits for concussions every year in the U.S.. Because many concussions are not reported, the three million documented cases are just the tip of the iceberg. An estimated 15 to 20 million people a year with concussions do not seek medical help and, as a result, go undiagnosed.   In a CBS News story, which drew attention to this issue in seniors, an  emergency room physician and geriatric specialist at Ohio State University Hospital, Lauren Southerland, stated “It’s not unusual for a 25-year-old athlete who received a blow to his head, to get a more thorough evaluation for a concussion than an elderly retiree.” 

Media attention on concussion risk in sports, such as football and hockey, has further heightened awareness of the long-term risks of concussions, and, recently, the CDC has been casting a spotlight on concussions and seniors.  The CDC’s National Center for Injury Prevention and Control has fall prevention resources for seniors, caregivers, healthcare providers and health departments.

Working Towards Effective Treatments

Despite the prevalence of concussions over many decades and advances in so many areas of medicine, there have been few advances in concussion treatment.  Prevention measures in all realms of life are a positive step and doubtless can and will continue to be improved, but even with these measures, concussions will not be eliminated.  Effective therapeutic treatments and may be closer at hand, thanks to advances in molecular biology and in our understanding of how the brain works.

Currently there are a number of companies working on concussion medicines intended to treat symptoms and underlying damage.  Our company, Oxeia Biopharmaceuticals is in Stage 2 clinical trials.

Previous work has found that a concussion causes damage inside the brain, particularly to glial cells, that in part disrupts the flow of information from one part of the brain to another. Central to Oxeia’s treatment is a hormone called ghrelin, which is a molecule that has neuroprotective properties and helps stabilize energy production and use in brain cells.

If all goes well, doctors could be prescribing the first drug to specifically treat concussions in as few as five years.

This will be a huge milestone because fewer than two decades ago, little was known about the serious effects of concussions, even though the condition was recognized in the 10th century by the Persian physician, Rhazes, in the 10th century. For researchers and others who work hard to bring a breakthrough medicine to market, the effort is often personal. The founders, researchers and physicians of our company have experienced concussions in their personal lives and understand the debilitating symptoms can significantly impair normal activity. New treatment options for patients are greatly needed.  Rest is not enough.

Preventing Fatal and Serious Injuries Caused by Distracted Driving

April was National Distracted Driving Awareness Month. Let’s get serious about preventing distracted driving accidents every month. While there are many potential distractions that interfere with driving – changing stations on the radio, talking on your phone,  and eating, to name a few – texting is one of the most dangerous and common distractions.  The National Transportation Highway Transportation Safety Administration (NHTSA) says that at 55 mph, taking your eyes off the road for five seconds to send or read a text is the equivalent of driving the full length of a football field with your eyes closed. 

Although many states have laws that are intended to prevent distracted driving, the CDC reports that nine people are killed every day in the U.S. as a result of a distracted driver.  According to the NHTSA, over 3100 people (8.2% of all fatal accidents) were killed in motor vehicle accident involving a distracted driver in 2021, a 12% increase over 2020.  325,000  were injured in crashes involving a distracted driver in 2020. The injured include not only drivers and occupants of the driver’s and other vehicles, but also pedestrians and bicyclists.

The most common injuries caused by distracted driving are head trauma, broken bones and internal bleeding.  In fact, car accidents of all types are among the most common causes of traumatic brain injury or TBIs.  Even concussions, or so-called mild traumatic brain injuries, can cause years and years of debilitating symptoms, including headaches, dizziness, blurred vision, light and noise sensitivity, as well as issues with concentration, memory  and mood.

Using common sense while driving can eliminate many of the distractions that cause accidents,  preventing needless death and injury for hundreds of thousands every year.  AAA offers these ten sensible tips[1] to avoid distractions while driving:

10. Fully focus on driving. Do not let anything divert your attention, actively scan the road, use your mirrors and watch out for pedestrians and cyclists.

9. Store loose gear, possessions and other distractions that could roll around in the car, so you do not feel tempted to reach for them on the floor or the seat.

8. Make adjustments before you get underway. Address vehicle systems like your GPS, seats, mirrors, climate controls and sound systems before hitting the road. Decide on your route and check traffic conditions ahead of time.

7. Finish dressing and personal grooming at home – before you get on the road.

6. Snack smart. If possible, eat meals or snacks before or after your trip, not while driving. On the road, avoid messy foods that can be difficult to manage.

5. Secure children and pets before getting underway. If they need your attention, pull off the road safely to care for them. Reaching into the backseat can cause you to lose control of the vehicle.

4. Put aside your electronic distractions. Don’t use cell phones while driving – handheld or hands-free – except in absolute emergencies. Never use text messaging, email functions, video games or the internet with a wireless device, including those built into the vehicle, while driving.

3. If you have passengers, enlist their help so you can focus safely on driving.

2. If another activity demands your attention, instead of trying to attempt it while driving, pull off the road and stop your vehicle in a safe place. To avoid temptation, power down or stow devices before heading out.

1. As a general rule, if you cannot devote your full attention to driving because of some other activity, it’s a distraction. Take care of it before or after your trip, not while behind the wheel.

[1] https://exchange.aaa.com/safety/distracted-driving/tips-for-preventing-distracted-driving/

Protecting our Youth Athletes from Concussion is a Top Priority

The month of April is a lot of things to a lot of people.  We can celebrate Military Child Month, Stress Awareness Month, Garden Month and even Financial Literacy Month.  But here at Oxeia, we take special note that April is National Youth Sports Safety Month. 

1.35 million kids are seen in emergency rooms every year for sports related injuries, says Safe Kids Worldwide.  According to their report that studied the 14 most popular sports, concussions account for 163,000 of those ER visits, or 12 percent.  That’s a concussion-related ER visit every three minutes.  Clearly, not enough is being currently done to raise awareness about the dangers of sports-related concussions can do to the brains of our young athletes. 

Most of us are unlikely to attend an educational forum or seminar on young athletes and concussions to mark Youth Sports Safety Month.  That’s okay.  Instead, parents should take the time to educate themselves about concussions.  Understand what a concussion is, the symptoms to look for, when to get medical care, when to return to normal activity and more.  Think about middle and high school students that you may know… or may even be raising. They are likely not yet able to make informed decisions about the risks they are taking on the playing field, making it all the more important that parents make informed decisions for their children, as well as have the ability to spot concussion symptoms on and off the playing field.

Here are some things to keep in mind for your young athlete:

•       Although the numbers and percentages of concussions from boys’ American high school football vary among studies, they agree that football is the leading cause of concussions. For girls, the leading cause of concussions in high school sports is soccer.[1]

•       A recent Centers for Disease (CDC) study reports that youth tackle football athletes ages 6 to 14 sustained 15 times more head impacts when compared to flag football athletes during a practice or game.  They sustained 23 times more high-magnitude head impact.

•       Another CDC study found that youth tackle and flag football athletes sustained two times more head impacts during a game than during a practice.

•       Go to the CDC Heads Up website to learn more about how parents can lower your child’s chances of sustaining a concussion, how to spot a concussion, what to do if you suspect your child has a concussion and more.  

Physical activity and team sports offer important physical fitness and social and emotional skills.  While whether or not your child plays a sport is an individual decision, measures to reduce the number of sports-related concussions in our youth should be a top priority. 

School Spring Sports and Concussion

A recent MedStar Health survey showed that concussion safety is top of mind for parents heading into spring sports season. 93% have concerns about concussions compared to just over half of parents in a 2019 study. The survey of parents also found that 91% believed that coaches should have concussion protocol and CPR training.

At the same time that parents have a heightened awareness of the possible long-term and often debilitating effects of concussions, the study also revealed a, perhaps, surprising confusion over concussion management.  According to the study a vast majority, 89% of respondents believe that it’s essential to stay awake after sustaining a concussion.  In fact, keeping concussion patients awake or waking them every hour or two was the standard of care up until about a decade ago. Today, CT and MRI scans can rule out a more serious injury.

65% of respondents also believe that helmets prevent concussions.  While some product manufacturers make this claim, studies don’t back up this claim. Helmets are, in fact, designed to decrease the possibility of a skull fracture or serious injury to the brain.  Believing that helmets are concussion-proof can lead to players taking greater risks, increasing their chances of sustaining a head injury.   

Despite increased media attention to concussions, almost half of the respondents believed that concussions occur solely from a direct hit to the head.  Concussions can be caused by a hit to the head or a rapid acceleration-deceleration movement that causes the brain to bounce around inside the skull.  We commonly think of these jolts to the head occurring in car accidents with whiplash, but they are common in many sports, as well.

On a positive note, the survey results indicate that a vast majority of respondents understand that athletes need to be taken out of play or practice after sustaining a concussion.  However, 13% believed that an athlete can stay in the game after a head injury if they don’t lose consciousness.  According to the Centers for Disease Control, most people do not lose consciousness after a concussion.

The heightened parental awareness of the seriousness of concussion is a positive step, but as this survey reveals there is still work to be done to further parents’ understanding of how concussions are sustained, the effectiveness of helmets and treatment post-concussion.  When an athlete sustains a concussion he or she should be seen by a doctor for tests and possible referral to specialists. Instructions from the doctor(s) should be followed carefully and athletes should not return to play until a doctor with concussion experience clears the athlete to participate in athletic activities again.  Learn more at the CDC’s Heads Up for Sports website.

At the same time that parents have a heightened awareness of the possible long-term and often debilitating effects of concussions, the study also revealed a, perhaps, surprising confusion over concussion management.  According to the study a vast majority, 89% of respondents believe that it’s essential to stay awake after sustaining a concussion.  In fact, keeping concussion patients awake or waking them every hour or two was the standard of care up until about a decade ago. Today, CT and MRI scans can rule out a more serious injury.

65% of respondents also believe that helmets prevent concussions.  While some product manufacturers make this claim, studies don’t back up this claim. Helmets are, in fact, designed to decrease the possibility of a skull fracture or serious injury to the brain.  Believing that helmets are concussion-proof can lead to players taking greater risks, increasing their chances of sustaining a head injury.   

Despite increased media attention to concussions, almost half of the respondents believed that concussions occur solely from a direct hit to the head.  Concussions can be caused by a hit to the head or a rapid acceleration-deceleration movement that causes the brain to bounce around inside the skull.  We commonly think of these jolts to the head occurring in car accidents with whiplash, but they are common in many sports, as well.

On a positive note, the survey results indicate that a vast majority of respondents understand that athletes need to be taken out of play or practice after sustaining a concussion.  However, 13% believed that an athlete can stay in the game after a head injury if they don’t lose consciousness.  According to the Centers for Disease Control, most people do not lose consciousness after a concussion.

The heightened parental awareness of the seriousness of concussion is a positive step, but as this survey reveals there is still work to be done to further parents’ understanding of how concussions are sustained, the effectiveness of helmets and treatment post-concussion.  When an athlete sustains a concussion he or she should be seen by a doctor for tests and possible referral to specialists. Instructions from the doctor(s) should be followed carefully and athletes should not return to play until a doctor with concussion experience clears the athlete to participate in athletic activities again.  Learn more at the CDC’s Heads Up for Sports website.

CONCUSSIONS ARE MORE THAN JUST A BUMP ON THE HEAD

While the Covid-19 pandemic temporarily shielded other disease and injury from view, they didn’t go away. One of those is brain injury, generally known as concussion or mild traumatic brain injury (mTBI). Once considered relatively harmless and treated by simple rest and rehabilitation, concussions are now widely recognized as a major ongoing public health issue. Concussion remains one of the main causes of loss of work or school time and it’s been known to lead to alcohol and drug abuse and domestic violence.

Concussion can be caused by blunt force trauma, repeated blows to the head, falls, vehicular accidents, explosions, military combat operations and training or physical assault, to name a few. According to the U.S. Centers for Disease Control and Prevention, almost three million patients with suspected brain injury visit the emergency room every year in the U.S. Other studies put the number much higher at 5 million, with as many as 2.4 million of these with mTBI. The numbers may even be higher with additional studies suggesting that as many as 50 percent of concussions go unreported.

These traumatic events send an energy shockwave through the skull leading to the depolarization of brain cells and metabolic dysregulation. Sometimes axons, the communicating arm of nerve cells, can be stretched and damaged as the brain moves within the skull from the concussive forces. In more severe brain injury, bleeding may occur causing inflammation, brain swelling and further damage.

Interestingly, concussions and other neurodegenerative diseases such as Alzheimer’s, dementia and Parkinson’s disease share a similar molecular pathology including mitochondrial dysfunction, where the ability of the mitochondria to convert sugar into energy for the brain is disrupted.  Understanding this biology may lead to the design and development of targeted therapeutic solutions.

We must accelerate our efforts toward finding a therapeutic for concussion.  Let’s see more players from the medical establishment, government, sports, and investment and large pharmaceutical companies commit to meaningful action to support finding effective treatments for concussions. Rest is not enough.

Vishal Bansal, M.D., F.A.C.S., is the Chief Scientific Officer and Co-founder at Oxeia Biopharmaceuticals and Director of Trauma Surgery at Scripps Mercy Hospital in San Diego.  Oxeia is a Boston-based clinical stage biotech company focused on the development of its lead molecule, OXE103, for the treatment of concussion.  The company is conducting Phase 2 human clinical studies for OXE103.

It’s March Madness Time: What’s the Concussion Risk in Basketball?

The effect of concussions on pro athletes has been investigated in many sports over the past couple of decades.  The concussion incident rate in pro football was recognized as a true health risk around the turn of the millennium and concern has been mounting as we learn about the potential long-term and often debilitating effects of concussions impacting players. 

Other sports, like hockey and soccer, are also reckoning that concussions are threatening the health and well-being of their players.  What about basketball?

The media haven’t covered  concussions in basketball to the same extent as football.  Similarly, few sports concussion studies have included the game of hoops.  But just because basketball concussions aren’t being studied or covered extensively, doesn’t mean they aren’t happening.  In response to concussions in basketball, both the NBA and the NCAA have implemented protocols guiding return to play after concussions.

University of Connecticut women’s basketball star Caroline Ducharme is a case in point.  As March Madness fever hit, Ducharme’s ability to play was in doubt.  She has a history of getting concussions and was sidelined and in concussion protocol while coping with concussion symptoms – migraines, neck pain and sensitivity to light and noise.  UConn Huskies women’s basketball fans worried about her missing 13 games this winter, and even after it was announced that she would play in March Madness, many wondered about her ability to compete in the season’s grand finale.

A study published in The Orthopedic Journal of Sports Medicine in 2019 noted that there is concussion risk in basketball.  They reported  that 189 concussions were reported to the NBA from 1999 to 2018.  Concussion incidence in NBA players is approximately 17 instances per season. 

Maybe the concussion numbers in pro basketball don’t rival the numbers in the NFL, but that doesn’t mean players should worry less.  Concussions in school basketball are especially high.

Basketball is the most popular sport for youth ages 8 to 19.  Basketball is second to football in school sports concussions.  Body-to-body contact such as setting hard screens and taking charges, hard falls and whiplash injuries are serious concerns.  Neural Effects analyzed data for 2018-2019 from the National High School Sports-Related Injury Surveillance Study. According to the study girl high school basketball players have higher rates of concussions than boys. Boys had a total of over than 9,000 concussions while girls experienced more than 17,000 concussions.

Basketball concussions don’t tend to have the drama of football concussion injuries, but they are a concern and parents and coaches need to recognize a possible concussion and take appropriate action.  The Center for Disease Control’s “Heads Up Concussion in Sports Guide for Coaches” is a good place to educate both coaches and parents about concussions.. 

Senator Mitch McConnell’s Concussion is a Strong Reminder:We Need to Do More to Find Effective Treatments

We see a lot about concussions in sports and over the past few years there’s been more reporting on concussions in the military, as well. Concussions from falls, however,  don’t make noise – unless as was the case with Senator Mitch McConnell – it happens to someone famous.  Despite the silence when it comes to concussions from falls,  falls are the leading cause of concussion. Falls are responsible for almost half of TBI-related hospitalizations. 

Falls are even more ubiquitous among people 65 and older. The CDC reports that more than 80,000 seniors have a TBI every year and more than half of these are from falls.  Common symptoms for concussion sufferers include headaches, confusion, dizziness, memory and visions problems and fatigue. Fortunately, most seniors with a concussion will recover fully within a couple of months.  However, if we consider that in the general population nearly half of concussion sufferers continue to have at least one symptom one-year post-injury, this doesn’t bode well for our senior population.  Add to that research that suggests there may be a link between TBI and cognitive decline.   With the aging baby boomer population, we are likely to see more concussions related to falls, an increasing burden on our healthcare system and caregivers and skyrocketing medical costs unless we take proactive steps.

When we consider that in the U.S. the number of persons older than 65 years is expected to increase from about 35 million in 2000 to an estimated 71 million in 2030, it’s clear we need to do more in the areas of prevention to reduce the risk of and numbers of falls, diagnostics to quickly and accurately detect concussions and treatment that will treat both the symptoms and underlying damage caused by a concussion.  We hope that Senator McConnell will see a full and rapid recovery, but let’s consider his fall and concussion a strong reminder that Congress and the Administration need to be doing more to prevent, diagnose and treat concussions.

Michael Wyand, DVM, PhD, is the CEO of Oxeia Biopharmaceuticals. Oxeia is conducting Phase 2 human clinical studies for its therapeutic drug, OXE-103, to treat concussions. 

Let’s Not Fail our Veterans: It’s Time to Find a Cure for Concussions

Patricia Kime and Rebecca Kheel’s article, Lost Years and Missed Opportunities: How the Pentagon Squandered the Chance to Combat Brain Injuries shone a light on TBI as “the signature wound” of post-911 wars and “one of the biggest factors” in suicide among veterans. 

Despite the end of the conflicts in Iraq and Afghanistan, the problem of suicides among those who served persists.  Whereas there’s been a  slight decline over the past two years in suicides nationwide, the number of suicides in the military has increased.  From 2015 to 2020 suicides increased by 40 percent, according to the Department of Defense.  More recent research, reports that 30,177 active personnel and veterans who served post 9/11 died by suicide in 2021. 

Concussions, also known as mild traumatic brain injury (mTBI), are the most common type of TBI for members of the military. The Department of Defense reported 430,000 head injuries among active-duty military between 2001 and 2018 with the vast majority ­82% – classified as mTBI.

Now recognized as an epidemic, mTBI has become one of the highest priorities in public health because of its tremendous costs and possible long-term consequences. The government is keenly aware of the impact concussions have on service members and veterans.  Both the Department of Defense and the Veterans Administration have sponsored programs to enhance the understanding of what causes concussions, as well as identify treatments and recovery protocols for mTBI. The Senate and House National Defense Authorization Act for 2022 directs increased funding for brain injury research.   

Tapping military might is logical to advancing research and finding effective therapeutic treatments for mTBI.  Our military has a special ability to get the job done.  Like the working committees formed to combat Covid-19, the military has the might to galvanize disparate groups of professionals to share research and resources to power ahead for solutions.  The private sector players, many of which are biopharma start-ups, will gladly welcome the Pentagon leadership and participation in advancing clinical trials.

Effective treatments for mTBI can also result in significant cost savings.  While symptoms disappear for many concussion sufferers within days, research indicates that almost 40% of mTBI patients have post-concussion symptoms (PCS) lasting more than three months.  A study examining recovery of PCS patients found only 27% of their population eventually recovered.

These often debilitating symptoms require ongoing physical, speech, cognitive, vision, occupational and/or drug therapies for our active military and veterans.   Studies have also linked mTBI with depression and PTSD, and repeated mTBIs with various neurodegenerative diseases.  For example, studies have shown that veterans with a history of mTBI have a 56% higher risk of developing Parkinson's disease within 12 years of their injury,

Many of these impairments can negatively affect readiness and job performance for active military and ongoing problems for employment, as well as for families and the larger community.

Progress toward a treatment for TBI to help our servicepeople and veterans will also be a boon to the public at large.  In the past couple of decades, awareness about the dangers of concussions has led to extensive news coverage of active and retired professional football players, and other athletes.  Today our citizens are more likely to realize that a slip in the bathtub or a car crash, can lead to injuries that are not seen by the naked eye.  The costs of treating concussion for the general public are already staggering.  The American Association of Neurological Surgeons puts annual direct and indirect costs of the full spectrum of TBIs – from mild to severe – are $76.5 billion.  Approximately 75% of all TBIs are mTBI.

As New York Senator Kristen Gillibrand remarked at a December 2017 Senate Armed Services Committee meeting; “If the military figures this out, then the rest of us can too.”

Michael Wyand, DVM, PhD, is the CEO of Oxeia Biopharmaceuticals. Oxeia is conducting Phase 2 human clinical studies for its therapeutic drug, OXE-103, to treat concussions. 

Learning from the Mistakes with Tua Tagovailoa: Let’s Find a Cure for Concussions

It was unbelievably difficult to watch as Miami Dolphins quarterback Tua Tagovailoa took that scary hit to his head during the game against the Cincinnati Bengals on September 29th. Just days earlier after taking a hit to the head in the game against the Buffalo Bills,  fans watched as Tua stumbled and  subsequently left the field.  It seemed obvious as a viewer that he was in the concussion protocol … until we saw him back after halftime.  Should he have even been playing in the game against the Bengals just days after apparently suffering a head injury just a few days earlier?  Despite showing gross motor instability after a hit in the game against the Bills, Tua was not in concussion protocol. 

There are better protocols and other safety measures today then there were just a few years ago, such as independent neurologists at games.  These measures clearly failed Tua. 

There’s no doubt that players have competing interests.  They want to get back into the game, yet maybe – probably – they often  shouldn’t. It’s their careers vs. their health.  There are people out there whose job it is to evaluate the players and make informed decisions about whether it’s safe for them to go back into the game or into concussion protocol.  After the events with Tua, there was an investigation into his injuries, and the NFL and the NFL Players Association have agreed that protocols have to change “to enhance player safety.”  The updated protocol adds ataxia — or gross motor instability — to the list of  symptoms that call for the immediate removal of a player from a game.

There’s so much we don’t yet know about brain injuries, but scientists are learning more every day about brain injuries and how the brain works.  We know, for example,  that often debilitating symptoms can last for months and years. Over the past 20 years research has increasingly linked concussions to neurogenerative conditions, including dementia, Alzheimer’s disease and CTE, a degenerative brain disease.  Scientists at Boston University found CTE in 99% of the brains from former NFL players. 

For me this points to the need to dramatically increase our focus on effective treatment for concussions.  Treatment hasn’t changed much since football was invented back in the 1880s.   Despite huge advances in other areas of medicine, there are currently no effective pharmacological FDA-approved treatments for concussion. I hope to help change that.  Just over five years ago I joined a small clinical stage company, Oxeia Biopharmaceuticals, that has a concussion drug that has shown promising interim results in a Phase 2 clinical trial.

Biopharma companies need entities to advance their research so they can develop treatments for a concussion’s immediate symptoms, as well as the underlying damage.  Perhaps those with a vested interest in finding a cure should step up to the plate.

While Tua’s injuries triggered national debate about concussions and football, if we’re honest with ourselves, much of the appeal of football for players and fans alike is the speed, the power, the hits, the risk, and the violence.  We’re never going to make the game of football 100% safe, but we owe it to football players to make it as risk-free as possible with a combination of safety measures and effective treatments, so that we don’t fail all the future Tua Tagovailoas at every level of football. 

Michael Wyand, DVM, PhD, is the CEO of Oxeia Biopharmaceuticals. Oxeia is conducting Phase 2 human clinical studies for its therapeutic drug, OXE-103, to treat concussions.  www.oxeiabiopharma.com

Crisis on Our Roads: Risky Driving Behavior Is Causing More Fatalities and Brain Injuries

Reckless, aggressive and distracted driving and failure to wear seatbelts all contributed to what Transportation Secretary Pete Buttigieg has called  a crisis on our roads.

Contrary to many people’s expectations that fewer cars on the road and fewer miles traveled would lead to a decrease in traffic accidents, crashes and traffic fatalities started to spike in 2020.  The National Highway Traffic Safety Administration’s (NHTSA) early estimates of traffic fatalities in 2021 showed a continuation of this dangerous trend. The agency estimated that there were about  43,000 traffic deaths in 2021 – the highest number since the data began being collected in 1975.  According to the NHTSA, these spikes may be a result of speeding, not wearing a seat belt and driving under the influence of alcohol or drugs.

What are we seeing in 2022 with more people resuming everyday activities, including  going back to school and work?  Early estimates for the first quarter of 2022 showed another record-breaking 7% increase in motor vehicle fatalities over the same period in 2021.

Some records are meant to be broken. This isn’t one of them. 

There are plenty of accidents where the occupants walk away seemingly unscathed or with minor injuries.  Those with no visible injuries are typically counted as the lucky ones.  But are they?  How many of these accidents result in concussions that go undiagnosed and untreated concussions until sufferers of long-term post-concussion symptoms go to their doctor?  Higher speeds on our roads translate into greater impacts in a crash and a higher likelihood of the brain being traumatized.  One doesn’t have to be knocked unconscious to have suffered a concussion.  In a motor vehicle accident, concussions can be caused when the driver and passengers hit their heads on the windshield or another object, as well as when they are violently thrown forward and backward.  When these traumatic events happen the human brain literally bounces around inside the skull. These abrupt movements can cause the connections between nerve cells to stretch and cause problems with connectivity within the brain. Intra-cranial bleeding may also occur and inflammation can cause brain swelling and further damage.

According to the U.S. Centers for Disease Control and Prevention, almost three million patients with suspected brain injury (from all causes) visit the emergency room every year in the U.S. Other studies put the number much higher at 5 million, with as many as 2.4 million of these with mTBI. The numbers may even be higher with additional studies suggesting that as many as 50 percent of concussions go unreported .

Fortunately, most people recover from their concussions in a few weeks, but as many as one third of patients do not fully recover from their concussions.  Some have debilitating emotional and physical symptoms that continue to plague them for months and years.  Headaches; depression; cognitive, memory, vision and balance issues; and sleep disorders can make it difficult to function at work and at home.  Currently, treatment options for traumatic brain injury (TBI), concussion included, are limited to mostly rest and pain relief. To date there are no effective pharmacological FDA-approved treatments for concussion

Oxeia is among the companies working to develop a much needed therapeutic that will treat the underlying pathology of concussion. However, we are still at least three to five years away from possible FDA approval.  And, even when we have an effective treatment, as the Dutch philosopher Desiderius Erasmus is purported to have said around 1500, “prevention is better than cure.”

Distracted, aggressive, impaired and reckless driving can have severe negative life altering consequences.  Everyone can do his and her part to prevent accidents on the road. The American Red Cross offers these car travel highway safety tips to help make our roads safer and protect yourself and others from becoming the next statistic:

• Buckle up, slow down, don’t drive impaired.

• Be well rested and alert.

• Use caution in work zones.

• Give your full attention to the road. Avoid distractions such as cell phones.

• Observe speed limits – driving too fast or too slow can increase your chance of being in a collision.

• Make frequent stops. During long trips, rotate drivers. If you’re too tired to drive, stop and get some rest.

• Be respectful of other motorists and follow the rules of the road.

• Don’t follow another vehicle too closely.

• If you plan on drinking, designate a driver who won’t drink.

• Clean your headlights, taillights, signal lights and windows to help you see, especially at night.

• Turn your headlights on as dusk approaches, or if you are using your windshield wipers due to inclement weather.

• Don’t overdrive your headlights.

• If you have car trouble, pull off the road as far as possible.

Concussion tied to poor youth academic, emotional and behavioral outcomes

Several recent studies shine a light on the deleterious impact of concussions on our youth.  In one of the studies, researchers from Seattle-based, University of Washington found that those having one or more concussions within the past 12  months had a 25% risk of poor academic standing “experiencing multiple concussions could be particularly harmful on student outcomes.” 

Another study by researchers at the University of Rochester’s Del Monte Institute for Neuroscience revealed that children who suffered a traumatic brain injury have more emotional and behavioral problems than those that do not experience a concussion.  Even those who had mild traumatic brain injuries (also known as a concussion) showed an increased risk (15%) of an emotional or behavioral problem. The risk was the most pronounced in those children that were around 10 years old.

For parents making the decision about whether to allow their children to play a sport is not clear cut.  On the one hand these and other studies about the short- and long-term impacts of concussions warn us away from youth sports, yet on the other hand, studies have consistently shown the physical, mental and social benefits of sports, including  physical health, improved self-confidence, reduced stress, greater concentration, teamwork and peer acceptance.

So, do you allow your child to participate in sports or not?

Neither option is satisfactory.

We have found cures for countless diseases, yet not for concussion.  We can take precautions to minimize the risk of concussion in sports, but concussions don’t only occur on playing fields.  They are commonplace and take place as a result of falls, playground collisions,  motor vehicle accidents, bicycle crashes and more. 

Our company, Oxeia Biopharmaceuticals, is one of a number of companies in the race to find a treatment for concussions, and we support the efforts of all that are searching for a cure.  Oxeia’s drug, OXE103, is being tested in a Phase 2 clinical study at the  University of Kansas Medical Center.  OXE103 is synthetic human ghrelin, an endogenous hormone. OXE103 freely crosses the blood-brain barrier and is now being tested in humans to potentially treat concussions by addressing underlying neuro-metabolic dysfunction and axonal injury. OXE103 uniquely targets the hippocampus region of the brain, an area important for cognition and memory.

We recently reported positive interim results of our Phase 2 trial and are hopeful that our drug will be successful.  However, we are still at least three to five years from when we can expect to see any our therapy approved by the FDA. 

The mostly small clinical stage companies working to develop successful concussion drugs do not have the resources to move the race for the cure along as quickly as we would like.  We need investment from individuals, institutional investors and from the government to bring a treatment to market.  The sooner we get a reliable, proven treatments for concussions, the better not only for parents of young athletes, but for all of us.

Keeping Your Summer Fun and Safe: What to Know About Concussion

June 21st marked the first day of summer 2022.  Summer is a time for outdoor fun and recreation for people of all ages. It’s also a time when hospital emergency rooms see an increase in the number of concussions from those same recreational activities, including bicycling, swimming, diving, rollerblading, skateboarding, ATVs and sports. 

Despite the increased risk of concussion in the summer, staying active is important at all ages and stages of life. Having a safe and healthy summer starts by educating yourself about:

-        safety precautions,

-        how to avoid undue risk,

-        signs of a concussion or other traumatic brain injuries, and

-        when to seek treatment for yourself, a friend or a family member.

Safety precautions and avoiding undue risk will depend upon a number of factors, such as the activities and the ages and experience level of participants.  Precautions include, but are not limited to, wearing a properly fitting helmet, obeying traffic signs and signals  when bicycling, skateboarding or rollerblading; participating in age-appropriate sports and recreational activities; avoiding diving in shallow water or water where you don’t know the depth; and following the rules for sports, recreational activities and equipment that are there to keep you safe.

How do you know if you’ve had a concussion?

Even when you take precautions to avoid injury, concussions can still occur.  A concussion  may result from a bump, blow a jolt to the head. When this happens the human brain literally bounces around inside the skull. Sometimes nerve cells can be twisted or even sheared. Not all blows to the head result in a concussion, which is also known as a mild traumatic brain injury (mTBI.)

While a concussion can cause you to lose consciousness, most people do not.  Most people also recover from symptoms of a concussion in a matter of days or several weeks, but up to one third of concussion patients do not fully recover from their concussions.  Concussion symptoms include chronic headaches, depression, problems with thinking and memory, vision and balance issues, and sleep disorders.[1]

What do you do  if you suspect a concussion was sustained?

Because the symptoms of a concussion can be subtle, it’s critical that you and those around you can recognize the signs and get the medical care needed following injury.  If you suspect that you, a friend or someone in your care sustained a concussion, contact a health provider as soon as possible.  If any of the following danger signs are present, the Centers for Disease Control directs to seek emergency care immediately:

-        have a headache that gets worse and does not go away,

-        experience weakness, numbness, decreased coordination, convulsions, or seizures,

-        vomit repeatedly,

-        have slurred speech or unusual behavior,

-        cannot recognize people or places,

-        get confused, restless, or agitated,

-        lose consciousness, and

-        look very drowsy or cannot wake up. 

For children the danger signs include all of the above, as well as:

-        will not stop crying and

-        are inconsolable and will not nurse or eat.[2]

Your primary care or the emergency department doctor will provide post-concussion evaluation and neurological and cognitive testing. Brain imaging, overnight hospitalization for observation  and/or referrals to specialists may follow the initial medical evaluation.  There is no one size fits all for concussions.  Concussion care requires a personalized treatment plan which may be adjusted throughout the course of your treatment. 

A final takeaway for the summer

Have fun, stay safe and take any bump, blow or jolt to the head seriously.

[1] https://www.mayoclinic.org/diseases-conditions/concussion/symptoms-causes/syc-20355594

[2] https://www.cdc.gov/traumaticbraininjury/concussion/symptoms.html#danger-signs