SEPTEMBER 7,2016

Chronic Head Trauma in Athletes: The Debate Continues

CHRONIC TRAUMATIC ENCEPHALOPATHY

it is considered a neurodegenerative disease associated with previous head trauma and characterized by progressive neurologic and psychiatric symptoms.

-These changes in the brain can begin months, years, or even decades after the last brain trauma or end of active athletic involvement

-Symptoms of chronic traumatic encephalopathy (CTE) were first described nearly 100 years ago among boxers, yet it is only in the past decade that the interest in CTE has accelerated. This is in large part due to high-profile cases of CTE among former professional football players, which stimulated intensive media interest.

-Unfortunately, CTE can only be definitively identified after postmortem examination of the brain.

-- Nearly all of the evidence to date linking sports concussions to CTE and other types of dementia such as Alzheimer's disease has come from case reports, fuelling debate about the causes of the neuropathologic findings and the clinical observations.

STUDY SYNOPSIS AND PERSPECTIVE

- In general, case reports in the literature describe athletes who sustain repeated head trauma playing football or other contact sports and later in life experience mood disorders, headaches, cognitive and speech difficulties, and suicidal thoughts and aggressive behaviour. At autopsy, some of these athletes display pathologic findings that have been collectively labelled CTE, the authors point out.

- Yet, importantly, not all athletes who participate in contact sports experience the findings ascribed to CTE. Also, there are individuals who have headaches, mood disorders, cognitive difficulties, suicidal ideation, and other clinical problems ascribed to CTE who have never experienced repeated head trauma or had the pathologic post-mortem findings of those currently diagnosed with CTE.

"Given the profound public health implications of rapidly emerging CTE research, it is essential that the evidence pertaining to sports concussions and CTE be disseminated to the public, the scientific community, and clinicians who care for concussed athletes in a balanced and accurate manner," says Brian L. Edlow, MD, from Massachusetts General Hospital, Boston, and Holly E. Hinson, MD, from Oregon Health & Science University, Portland.

- As reported previously by Medscape Medical News, the National Institutes of Health (NIH) and the National Football League (NFL) recently funded 2 multicentre studies focused on defining the scope of long-term changes that occur in the brain years after a head injury or multiple concussions.

- Among the specific goals of this research are to establish and validate criteria for the histopathologic diagnosis of CTE, identify structural magnetic resonance imaging biomarkers of CTE in human brain specimens, and begin to identify in vivo magnetic resonance imaging biomarkers.

 

Magnetic Resonance Imaging

In Vivo Magnetic Resonance Imaging

CTE researchers will play an important role in framing the discussion: as more evidence emerges from prospective studies, stakeholders including athletes, parents, and policymakers will need to consider the risks of contact sports, and whether the rules need to be changed.

Conclusion