DRUG TO TREAT CONCUSSIONS
The High Incidence of Concussions Among the Elderly
The Problem is Significant but a New Treatment May Be on the Way
By: Doug Barry
DRUG TO TREAT CONCUSSIONS
The elderly suffer concussions at far higher rates than any other group and falls are the primary cause. According to a Center for Disease Control report, nearly four in five traumatic brain injury (TBI)-related emergency department visits, hospitalizations, and deaths in adults aged 65 and older were caused by falls.
“…new treatment options for patients are greatly needed. Rest is not enough.”
You may be thinking, “Here’s another depressing article about aging,” but there’s actually 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 TBI is caused by a bump or blow to the head that disrupts the normal function of the brain. The severity of a TBI may range from headaches, sensitivity to light and brief unconsciousness to extended periods of unconsciousness, memory loss and even death. The majority of TBIs are mild, but still pose great risk for seniors.
In 2013 there were 2.5 million hospital emergency room visits for concussions at a cost of more than $160 billion. Because many concussions are not reported, the three million documented cases could be just the tip of the iceberg.
“At these numbers, we are dealing with a significant public health issue,” said Kartik Shah, Chief Business Officer and Co-founder of Oxeia Pharmaceuticals, a San Diego-based company working on a medicine to treat concussions. “In our senior citizens, head injury has been associated with increased memory loss and a decline in cognition.”
The problem is further exacerbated by the incidence of undiagnosed concussions for those 65 and older. This was corroborated in a “CBS News” story, in which Lauren Southerland, an emergency room physician and geriatric specialist at Ohio State University Hospital, 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.” That will hopefully change as public awareness of the problem increases in the senior population just as it has in cases involving athletes and military veterans.
The association of chronic traumatic encephalopathy (CTE) with head injury in the early 2000s suggested concussions could have serious long-term consequences. For example, soldiers who suffered a mild TBI while deployed, yet reported little or no PTSD prior to deployment, had almost twice the probability of PTSD after deployment than what was predicted, according to study in JAMA Psychiatry.
Media attention on concussion risk in sports, especially football and hockey, has further heightened awareness of the long-term risks of concussions, and, recently, the Center for Disease Control has cast a spotlight on concussions and seniors.
Despite the prevalence of concussions over many decades, there have been few advances in treatment. Of prevention measures developed, such as permutations of the football helmet, none has provided reliable protection. Better results may be closer at hand, thanks to advances in molecular biology and in our understanding of how the brain works.
Race for the cure
Currently there are at least six companies working on concussion medicines intended to treat symptoms and underlying damage. All but one is at the animal testing stage. Oxeia has finished animal testing and is preparing for human 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.
Animal studies show synthetic ghrelin to have significant therapeutic potential, according to Shah. “Ghrelin administration in animals with a brain injury or neurodegenerative disease show improved physiomotor function and cognition.
“Examination of the brains of these animals after injury showed that the treated animals had less brain damage,” he said. “Separate animal studies have also shown ghrelin to induce neurogenesis and new synapses as well.” In other words, the flow of information disrupted in the brain by a concussion was restored.
“Rest is not enough”
Human testing is next, and this phase will take a couple of years after which the U.S. Food and Drug Administration will determine next steps. 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 less than two decades ago, little was known about the serious effects of concussions, even though the condition no doubt predates homo sapiens with our sensitive, vulnerable brains—unsuited for blows from caveman clubs, linebacker helmet hits or falls in the bathroom.
For researchers and others who do the hard work to bring a breakthrough medicine to market, the effort is often personal. Said Oxeia’s Shah, “The founders, researchers and physicians of our company have experienced concussions in our personal lives and understand the debilitating symptoms can significantly impair normal activity; new treatment options for patients are greatly needed. Rest is not enough.”