Number of Emergency Room Visits in the U.S. per year

The CDC estimates there are about 2.8 million TBIs each year – mostly from falls and automobile accidents – and about 60% of them completely recover within a year.  The remaining 40% – more than one million people per year – suffer ongoing cognition, motor, memory, mood and/or personality deficits that define this condition.  Moreover, the CDC estimates, the economic cost of TBI in the U.S. is at a staggering $4.2 Trillion dollars annually.

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To put TBI into perspective, the one million new cases of chronic TBI are more than all the newly diagnosed cases of breast, prostate, colon, and lung cancer combined. The company estimates that upwards of ten million people in the U.S. may suffer from chronic TBI. Although sports injuries are usually considered the leading cause of concussions and brain injury, the reality is that the leading causes of TBI related hospitalizations were falls and motor vehicle crashes with the leading causes of TBI related death being suicide and falls.

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TBI is an injury caused by an external force that disrupts normal brain function, such as a jolt, bump, blow to the head or a penetrating head injury.  The primary injury can be described as the mechanical damage occurring at the time of trauma to the neurons, axons, glia and blood vessels through shearing, tearing and stretching.  Such events pave the way for secondary pathophysiological cascades that include biochemical, metabolic and physiological changes such as ionic imbalance, release of excitatory neurotransmitters, mitochondrial dysfunction and activation of inflammatory and immune processes.  Survivors may experience a substantial burden of physical, psychiatric, emotional, and cognitive disabilities, which disrupt the lives of individuals and their families, and pose huge costs to society. 

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Post-concussive symptoms that persist beyond 3 months (late persistent symptoms) may be grouped into the following domains: 

• Neurologic -   headaches, neuro changes, eye tracking, auditory processing, etc.

• Cognitive - memory, attention, exec function, speed of processing, etc.

• Affect - depression, anxiety, PTSD, PTS symptoms, mood, change in personality

• Somatic - pain out of proportion to expectation, preoccupation with pain

• Cardiac – often neglected, but brain injured patients have increased cardiac death; may be due to autonomic dysfunction

• Neuro endocrine - changes in neuro endocrine axis with multiple outcome effects.

 

These symptoms vary from subject to subject and may be related to pre-TBI clinical states, the locations of the brain injury and neuropathological sequences caused by the TBI.

 

Management of post-concussion syndrome (PCS) typically involves treatments addressing specific symptoms; for example, patients can take non-opioid analgesics for headaches and medicine to relieve depression or insomnia.  Although no pharmacological treatments exist for PCS, doctors may prescribe medications used for symptoms that also occur in other conditions, for example, anti-depressants for the depression that frequently follows TBI.  Psychological treatment, to which about 40% of PCS patients are referred for consultation, has been shown to reduce symptoms.  Ongoing disabilities may be treated with rehabilitation therapy to improve function at work, social or other contexts.  Therapy aims to aid in the gradual return to work and other pre-injury activities, as symptoms permit.  

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There are currently no approved pharmacological agents for treatment of the arrays of persistent symptoms of post-concussive disorders. 

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