Contact sports, long term effects and CTE

The effects of chronic traumatic encephalopathy (CTE) are likely far more widespread than the National Football League (NFL) and thousands of combat soldiers in Iraq and Afghanistan. That evidence was presented this past Monday at the German Center for Research and Innovation (GCRI)  by two leading researchers in the field: Robert A. Stern, MD of Boston University and Inga Koerte, MD of the Ludwig-Maximilians-Universität München (LMU). The panel was moderated by Alan Schwarz of The New York Times, a freelance sportswriter/baseball stats expert-turned-concussion investigator/writer whose articles on sports concussions and long term effects are helping to change US sports safety. Update 10 June: video (1:38:00), event summary.

Dr. Stern detailed for this largely non-clinical audience post-concussive syndrome and the specific neurodegenerative/behavioral pattern of CTE including the startling tau neurotangles (but unlike Alzheimers, no amyloid presence). It is an old problem. The first research was published in 1928 in JAMA by Dr. Harrison Stanford Martland who documented what was for many years called Dementia pugilistica (DP). Dr. Stern’s research has focused on the long-term effects of repetitive brain trauma in athletes, including the post-mortem analysis published last October in Brain [TTA 6 Dec 12] as part of your Editors’ multi-part examination of TBI and CTE. His emphasis here was not on concussion–the ‘tip of the iceberg’ in his view–but cumulative sub-concussive blows which are never diagnosed, don’t have immediate effects and thus are hard to track. The shocker, for this Editor, was that typical ‘hits’ in US football typical in games and even practice can be up to 20Gs; ‘heading the ball’ and other contact moves in soccer matches can be 15Gs. The remaining questions without answers: is CTE statistically common, and why some contact sports players get it and others do not (risk factors).

Dr. Koerte is a specialist in neuroradiology and through her research has detected clear signs of brain tissue alterations in professional soccer players who specifically had not suffered from previous concussions, but may have suffered from mild traumatic brain injury (mTBI). Unlike in Dr. Stern’s research study, her subjects were alive and young (around 19 years in soccer, older in ice hockey). Using new techniques of neuroimaging including diffusion tensor imaging (DTI) and functional MRIs (fMRI), she found definitive brain changes in structure, metabolism and function.

Some conclusions: there are presently no helmets or devices on the market for preventing mTBI, but proper training/strength training in soccer in heading the ball, plus eliminating head butting in football practice can be helpful. Eliminating full contact sports for the young below age 14 was discussed–but not agreed! And the NFL has made more changes than any other sport to reduce observable head trauma by reducing contact practices by about 80 percent.

Many thanks to Jennifer Audet and Dr. Joann Halpern (Director) of the GCRI.

Related reading: (GCRI) Program information, (Innovation Germany) Sports-Related Head Injuries and Memory, Robert Wood Johnson Foundation blog interview with Alan Schwarz. Dr. Stern and his BU colleague Dr. Robert Cantu were interviewed in Slate on the possible role boxing head trauma may have played in the behavior of Boston Marathon terrorist Tamerlan Tsarnaev, and whether Tsarnaev’s brain should be tested.

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