[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/07/h_research_Figure-4.-Annotated-Normal.-Mild-CTE.-Severe-CTE.jpg” thumb_width=”200″ /]Updated for additional information and analysis at conclusion.
In the largest-ever case study published of CTE–chronic traumatic encephalopathy
—VA Boston Healthcare System (VABHS)
and the Boston University School of Medicine’s CTE Center
found mild to severe CTE pathology in nearly all of the brains of former football players studied. Jesse Mez, MD, BU Medical assistant professor of neurology and lead author on the JAMA study
, said that “The data suggest that there is very likely a relationship between exposure to football and risk of developing [CTE].” The CTE is marked by defective tau (stained red in the brain sample pictures, click to expand), which is also evident in Parkinson’s and Alzheimer’s Disease.
Of the 202 brains donated to the VA-BU-CLF (Concussion Legacy Foundation) Brain Bank:
- The most dramatic finding is the detection of CTE in 110 of 111 donated former NFL players’ brains (defined as having played one play in a regular NFL season game).
- In addition, the brains of other football players were studied. CTE was detected in seven of eight Canadian Football League former players (88 percent), nine of 14 semi-professional players (64 percent), 48 of 53 college players (91 percent), and three of 14 high school players (21 percent).
- The severity increased with length of play, with the majority of former college, semi-professional and professional players having severe pathology. The deceased high school players diagnosed with CTE had mild pathology findings. Age at death ranged from 23 to 89.
- Player position mattered. Linemen, running backs, defensive backs, and linebackers, who take most of the punishment in football, were the bulk of the donated brains with CTE.
Separately, and with no knowledge of the pathology, backgrounds on each donor were compiled to gather medical history and symptoms. What was striking were the personality changes evident with even mild CTE. Dr. Mez: “We found cognitive, mood and behavioral symptoms were very common, even among players with mild CTE tau pathology. This suggests that tau pathology is only the tip of the iceberg and that other pathologies, such as neuroinflammation and axonal damage, contribute to the clinical symptoms.”
Preliminary to the current study was UNITE (more…)
Not shocking to our Readers. In December, sports network ESPN reported that the National Football League (NFL) refused to fund research on detecting in vivo chronic traumatic encephalopathy (CTE) from a long-term $30 million unrestricted grant to the National Institutes of Health (NIH) [TTA 23 Dec 15]. A 91-page report by Democratic members of the House Committee on Energy and Commerce, which started after the December reports, confirmed that the NFL improperly attempted to shape the research after the grant, violating NIH peer-review process policies that stipulated no grantor interference. The NFL specifically objected to the objectivity of Boston University’s Robert Stern, MD heading up the $16 million project before the award in 2015, then tried to redirect the money, so to speak, in-house–to a group including Dr. Richard Ellenbogen, a member of the league’s panel on brain injuries and their bid for the project. Ultimately, the NFL withdrew the funding from the NIH, which went ahead with it. The project was awarded to BU, the Cleveland Clinic, Banner Alzheimer’s Institute (Arizona) and Brigham and Women’s Hospital in Boston.
The Congressional report’s six major conclusions were highly critical of the NFL in several ways and also scored the Foundation for the NIH for not acting as a ‘buffer’:
- The NFL improperly attempted to influence the grant selection process at NIH.
- The NFL’s Head, Neck and Spine Committee members played an inappropriate role in attempting to influence the outcome of the grant selection process.
- The NFL’s rationalization that the Boston University study did not match their request for a longitudinal study is unfounded.
- FNIH (Foundation for the NIH) did not adequately fulfill its role of serving as an intermediary betweenNIH and the NFL.
- NIH leadership maintained the integrity of the science and the grant review process.
- The NFL did not carry out its commitment to respect the science and prioritize health and safety.
When the grants were announced in September 2012 [TTA 7 Sept 12], there was great cheer that finally the NFL had decided that denial was, to use the old joke, a river in Egypt, and to do something about it. This also followed Army research on TBI being supported by the NFL. The first indicator that the funds were going elsewhere, as we noted a year later, was that a year later the Sports and Health Research Program (SHRP) funds were going to other medical problems like joint diseases and sickle cell anemia. While worthy, it had not been the prime publicized objective of the funds. The Congressional committee report also details how the NFL tried to steer the research away from Dr Stern, one of the leading researchers in the field, citing his support of players who refused to accept the CTE settlement in 2014. Beyond the NFL, research on CTE and concussion will impact any contact sports as well as the military and other head traumas. This Editor has previously reported on Dr Stern’s CTE research presentations in NYC and from other researchers in the field; search on NFL and Dr Stern both in current index and the back file. Congressional report, ESPN.com, New York Times.
In September 2012, the National Football League (NFL) donated $30 million to the Foundation for the National Institutes of Health (FNIH) to focus on brain injury. The Sports and Health Research Program (SHRP) now has a somewhat wider scope inclusive of joint diseases, sudden cardiac arrest, sickle cell anemia and hydration/heat injury. Last week they announced eight projects to be supported. Two ($6 million each) are cooperative agreements focusing on brain injury and after multiple concussions. These research projects are: Boston University, which has pioneered major CTE research [TTA 5 June], and the VA on CTE; the pathology of CTE and delayed TBI from Mount Sinai Hospital in New York City. The six other studies are ‘pilots’ totalling about $2 million over two years and range from cortical GABA in pediatric sports concussion, the Spot Light concussion management app developed by Inlightened, LLC, and eye movement tracking for concussion detection. FNIH release
Last week’s $765 million settlement by the National Football League (NFL) concluded a lawsuit in the works for over a year [TTA 7 Sept 12] that was brought by more than 4,500 players and their families. The more legally minded will argue that the NFL ‘got away with it’ before the season started; they admitted to no causal role between the game and traumatic brain injury (TBI) or chronic traumatic encephalopathy (CTE), which can only be confirmed post-mortem. The financial settlement sets small caps relative to the nature of the illness and the cost of care. What’s Unsettled About The NFL Concussions Settlement (Forbes) Also N.F.L. Agrees to Settle Concussion Suit for $765 Million (New York Times)
[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/09/nfl-surface.jpeg” thumb_width=”175″ /]If not an admission, player injury response may have been a factor in pushing the NFL into the 21st century. Concussion and injury assessment is a component of ‘Surface on the Sidelines’, part of a $400 million deal announced in May for official NFL adoption of the Microsoft Surface Pro
). Teams have used iPads in many areas away from the sidelines due to outmoded league regulations, but the New York Giants’ medical/trainer staff used iPads last season to assess player injuries and concussions [TTA 23 Oct 2012
]. Surface Pros are now loaded with the X2 app and database which stores player testing and medical history. Team doctors and trainers can now take down information on the field, make assessments and also to administer player self-testing. This allows faster determination of injury and if needed, to pull the player, although it cannot do what Gizmag
‘s headline claims it will: Could Microsoft Surface help the NFL to prevent brain injuries?
(photo, SurfaceForums.net) (more…)
Breaking news in the US today on a topic we’ve been following. Maryland-based Neuralstem, a developer of neurogenic drugs, announced this morning that it is working with the National Football League Alumni Association (NFLAA) to develop a trial of their NSI-189 for treating NFL alumni members suffering from traumatic brain injuries (TBI). According to their release, NSI-189 (or NS1-189, both are used) is currently in a Phase Ib clinical trial to treat major depressive disorder. Because it appears to work by stimulating neurons in the hippocampus, a region of the brain that atrophies in depression, this could also apply to brain injury. While this announcement is perhaps more than it seems–a Phase I clinical trial is ‘early days’, to make it through all four phases (I-IV) may take a decade, and now the developer is switching around the treatment condition–the drug itself has received support from DARPA and NIH which are both closely concerned with TBI. In addition, working with the NFLAA will help Neuralstem find subjects for the trials. PR Newswire via Baltimore Business Journal
Previously in TTA on TBI and the NFL: Further sad confirmation of CTE, Brain injury research study, NFL donates $30 million to NIH, Combating TBI on the battle and football fields.