Case Report: Buccal administration of hydrogen-producing blend after a mild traumatic brain injury in a professional athlete

Introduction

Sport-related concussion or mild traumatic brain injury (TBI) is a perilous trauma that could impair the brain function of an injured athlete both acutely and in a long-term perspective. Up to 3.8 million sport-related concussions occur in the United States annually¹, with contact sports (e.g. football, wrestling, soccer, boxing, basketball, ice hockey) accounting for the greatest number of concussions². Common signs and symptoms of acute mild TBI include physical (e.g. headache, dizziness, nausea, vomiting, fatigue), cognitive (e.g. loss of consciousness, post-traumatic amnesia, difficulties with concentration and memory), emotional (e.g. irritability, depressed mood) and sleep-related problems (e.g. drowsiness, sleeping disturbances)³. This happens probably due to a complex cascade of neurometabolic alterations in brain neurons damaged by head acceleration-deceleration mechanical forces⁴, with mitochondrial dysfunction, energy metabolism disturbances, and excessive oxidative stress might play a role⁵. Treatment solutions for sport-related concussion typically focus on complete rest at first (including a temporary withdrawal from practice and mental activities) followed by slow return-to-play activities monitored and clearance by a physician³. Non-traditional therapies, such as dietary supplements, enteral nutrition, acupuncture, and music therapy, are being considered to combat mild TBI, yet the therapeutic options remain limited⁶. Molecular hydrogen (H₂) has recently been set forth as an innovative neuroprotective agent⁷ that can easily reach hard-to-reach biocompartments⁸, yet no data are available concerning its value as a first-aid intervention in mild TBI. This case report demonstrates the efficacy and safety of a hydrogen-producing blend administered buccally in a professional athlete that suffered a sport-related concussion.

Case report

Follow-up and outcomes

SCAT2 profiles were obtained at every 6 hours during the first 24 hours post-injury (Figure 1). Total SCAT2 scores have risen from 68 (initial score) to 72 points at first re-evaluation period and continued to increase to 84 points at the final follow-up examination. In addition, the total number of concussion symptoms decreased to 9 at 24-h follow-up, with symptom severity score dropping to 12 (out of 132), while SLST balance test improved by 25% (total number of errors 2 out of 10 at 24-h follow-up). The patient reported no side effects of hydrogen intervention, as evaluated with an open-ended questionnaire administered at the end of each treatment period; the patient was asked if the intervention resulted in any adverse events, including oral irritation or discomfort, tingling in the mouth, dizziness, nausea or flushing.

Figure 1. Sport Concussion Assessment Tool 2 (SCAT2) total scores at baseline and at each 6-h follow-up interval.

Discussion

This case report implies the favorable effects of hydrogen-producing dissolving tablet administered buccally as a possible first-aid treatment to improve recovery in a professional athlete with a mild TBI. Previous animal studies have demonstrated neuroprotective effects of hydrogen against perinatal¹¹ and ischemic brain injury¹², or brain damage induced by neurosurgical intervention¹³. In a recent pivotal study¹⁴, TBI-challenged rats exhibited significant brain injuries that were characterized by decreased survival rate and increased blood-brain barrier permeability, brain edema, and neurological dysfunction, while hydrogen treatment ameliorated the consequences of TBI. The authors concluded that hydrogen could exert a neuroprotective effect against TBI and attenuate inflammation and/or oxidative stress¹⁴, which put forward the intervention as a possible therapeutic strategy for TBI patients. Using an innovative route of administration and a benchmark tool (SCAT2) to evaluate injured athletes for concussion, we affirmed here that oral hydrogen ameliorates the presence and severity of symptoms of sport-related mild TBI. However, hydrogen has not been compared to placebo so the degree of advantage that hydrogen may provide to standard medical procedures for concussion (e.g. physical and mental rest) remains open to question. We strongly suggest further monitoring of the efficacy and safety of oral transmucosal hydrogen in sport-related mild TBIs on a larger similar case series using randomized controlled trials.

Consent

Written informed consent was obtained from the patient for the publication of this case report, including any associated images.

Data availability

All data underlying the results are available as part of the article. No additional source data are required.