Archive for the ‘Chronic Traumatic Encephalopathy (CTE)’ Category

What's worse than TBI?

Friday, December 9th, 2011

play today, pay tomorrow?

In my last post I wrote about the immediate risk to our youngsters, that of traumatic brain injury (TBI). Now I'd like to move on to an even grimmer issue, much more severe and long-lasting brain damage that's also trauma-associated. We've heard of professional football players developing personality changes, then more severe neurological problems; most recently I read of a professional hockey player who had similar issues.

So I found the Boston Center for the Study of Traumatic Encephalopathy (that term translates as "disease, damage or malfunction of the brain."), and read one of their major publications on what is called Chronic Traumatic Encephalopathy   (CTE). Trust me, most of the medical jargon it uses is tough even for a Internal Medicine subspecialist. It was published in a journal I've never heard of, J Neuropathol Exp Neurol, but is very well written and, in addition to detailing the brain changes in 48 cases of CTE, provides an excellent background discussion of the entity. Ninety percent of the neuropathological confirmed cases of CTE were in athletes.

I remembered a story in 2009 of a 26 year old Cincinnati Bengals receiver who had died after falling out of a pickup truck during a domestic quarrel, reviewed the recent New York Times piece on a 260+ pound NHL "enforcer" who died of a combined alcohol and painkiller overdose and found another Times article, this one from May of 2011, about a former Chicago Bears defensive back who had committed suicide and donated his brain to the Boston research center. All three had CTE.

That article said about two dozen retired NFL players were eventually found to have this disease; the research article mentions that over one-sixth of those having repetitive brain injuries called concussion or mild TBI eventually will go on to have CTE .

But we're not just speaking of football players or hockey players. Professional wrestlers, soccer players, domestic abuse victims, military veterans, horseback riders, seizure victims, head bangers as well as boxers and hard-form martial arts participants may well have similar recurring brain trauma and potentially could go on to CTE.

It's time to study their brains, hopefully before it's too late.

The NFL donated $1 million in 2010 to CSTE, the Boston University research group; researchers at the center have lined up 100 former players  to try to find ways to diagnose the condition during life and more than 250 active and retired NFL players have agreed to donate their brains and spinal cords to the CSTE.

Nearly 100 are suing the league over the issue of player safety, saying the NFL has down-played the concussion problem to give fans more action. A knowledgeable friend told me the NHL allows bare-fisted fights between its enforcers and others to go on for roughly fifteen seconds; he said the audience loves the brutality.

Bread and circuses were a way to keep the Roman populace from revolting. Why are we emulating them?



It goes far beyond football, boxing and hockey

Wednesday, December 7th, 2011

The brain is vulnerable to trauma

I feel like I've opened the proverbial can of worms, finding, in this case, a topic that keeps expanding. I started with reading an article in The New York Times about the death of a professional hockey player, but I quickly delved into the medical literature.

I've spent much of the day reading article after article on traumatic brain injury  (TBI), which can be mild or severe, and another entity called chronic traumatic encephalopathy or CTE, one that's frequently been in the news over the last two years. Let's start with TBI. I'll be writing about teens and younger kids. I'll deal with CTE in another post focused on adults.

A Center for Disease Control and Prevention (CDC)  report in the most recent edition of the Journal of the American Medical Association reviewed nonfatal TBI related to either sports or recreational activities in kids age 19  or younger. The numbers involved were staggering, nearly 175,000 per year being seen in Emergency Departments (EDs).

A large majority of those sports and recreation-related TBI ED visits were by boys and the annual total of those ED trips increased markedly during that nine-year time frame. They were injured biking, playing football, soccer, basketball or while engaging in miscellaneous playground activities. They went to the ED in smaller numbers for injuries suffered in many other activities, including horseback riding, ice skating, ATV riding, tobogganing and even golfing (here the injuries included those related to golf carts). Surprisingly, skateboarding accounted for only a fourth of the ED visits for biking and football accidents and TBI was less frequently seen.

A helmet is a good start

As my wife and I drive around town, we often see college students riding their bikes at night while helmet-less and light-less. I fear for their brains.

There's another, less well-accepted entity, so-called "Second Impact Syndrome." I read an article about this in a February 2009 article by two authors on the faculty of the University of California, Irvine School of Medicine. In this scenario athletes who've had a TBI then have a second brain injury when they go back to playing their sport far too quickly. The initial injury may have been relatively mild; the recurrent trauma may kill them in a matter of minutes.

Another review of this  syndrome said 94 catastrophic head injuries had been reported in American high school and college football players in a 13-year time frame, 92 in high schoolers.  Seven of ten had a prior concussion in the same football season; over a third played with continuing symptoms.

This speaks to the crucial question of when an athlete (or a bike or horseback rider) who has suffered TBI should return to their sport/activity. Last night I called a younger friend who had been bucked off his spooked mare and suffered a concussion eight days ago. He was still having headaches and agreed with me that it was far too soon to get back on his horse.

A new CDC program called Heads Up offers TBI guidelines for coaches, parents and physicians.