By Jueseppi B.
Players of American football who committed suicide
Chronic Traumatic Encephalopathy (CTE)
Chronic traumatic encephalopathy (CTE) is a form of encephalopathy that is a progressive degenerative disease, which can only be definitively diagnosed postmortem, in individuals with a history of multiple concussions and other forms of head injury. The disease was previously called dementia pugilistica (DP), as it was initially found in those with a history of boxing. CTE has been most commonly found in professional athletes participating in American football, ice hockey, professional wrestling and other contact sports who have experienced repetitive brain trauma. It has also been found in soldiers exposed to a blast or a concussive injury, in both cases resulting in characteristic degeneration of brain tissue and the accumulation of tau protein. Individuals with CTE may show symptoms of dementia, such as memory loss, aggression, confusion and depression, which generally appear years or many decades after the trauma.
Repeated concussions and injuries less serious than concussions (“sub-concussions”) incurred during the play of contact sports over a long period can result in CTE. In the case of blast injury, a single exposure to a blast and the subsequent violent movement of the head in the blast wind can cause the condition
Signs and symptoms
Other than repeated brain trauma, the risk factors for CTE remain unknown. So far, CTE can only be diagnosed posthumously. Research studies are looking into possible genetic, exposure level, and other risk factors.
Research performed at the Cleveland Clinic and at the University of Rochester has shown that in addition to concussions, sub-concussive head hits also produce measurable changes in athletes’ MRI. Dr. Bazarian (University of Rochester) demonstrated persistent changes in white matter properties in athletes who did not experience a concussion during a season but had several blows to the head. This finding is consistent with the hypothesis that a number of sub-concussive events may be as damaging as a frank concussion. The MRI changes reported in this study were causally related to the presence in serum of players of auto-antibodies against the brain protein S100B. The sequence of events proposed by Dr. Janigro at the Cleveland Clinic links sub-concussion to leakage of the blood-brain barrier, extravasation of brain S100B in blood, activation of an immune response due to antigen unmasking and production of auto-antiboides. These auto-antibodies maybe pathogenic as shown for example in epileptic human brain. The link between S100B auto-antibodies and CTE needs experimental confirmation; however, antibodies against S100B or other brain protein have been found in patients affected by Alzheimer’s disease.
Clinical symptoms of CTE are only beginning to be understood. They are thought to include changes in mood (i.e. depression, suicidality, apathy, anxiety), cognition (i.e. memory loss, executive dysfunction), behavior (short fuse, aggression), and in some cases motor disturbance (i.e. difficulty with balance and gait). While the pathology of CTE has been broken up into stages, the clinical symptoms and clinical progression of CTE are not yet fully understood.
Between 2008 and 2010, the bodies of twelve former professional American football players underwent postmortem evaluations for CTE, and all of them showed evidence of the disease, indicating a conservatively estimated prevalence rate of 3.7% among professional football players if no other players who died during this period had CTE.
In 2002, Dr. Bennet Omalu, a forensic pathologist and neuropathologist in Pittsburgh, Pennsylvania found CTE in the brains of Mike Webster, Terry Long, Andre Waters, Justin Strzelczyk and Tom McHale. Omalu, in 2012 a medical examiner and associate adjunct professor in California, was a co-founder of BIRI and reportedly in 2012 participated in the autopsy of Junior Seau. Dr. Omalu’s participation was halted during the autopsy after Junior Seau’s son revoked previously provided oral permission after he received telephone calls from NFL management denouncing Dr. Omalu’s professional ethics, qualifications, and motivation.
As of December 2012, thirty-three former National Football League (NFL) players have been diagnosed post-mortem with CTE. Former Detroit Lions lineman and eight-time Pro Bowler Lou Creekmur, former Houston Oilers and Miami Dolphins linebacker John Grimsley, formerTampa Bay Buccaneers guard Tom McHale, former Cincinnati Bengals wide receiver Chris Henry, and former Chicago Bears safety Dave Duerson, have all been diagnosed post-mortem with CTE. Other football players diagnosed with CTE include former Buffalo Bills star running back Cookie Gilchrist and Wally Hilgenberg., among others.
An autopsy conducted in 2010 on the brain of Owen Thomas, a 21-year-old junior lineman at the University of Pennsylvania who committed suicide, showed early stages of CTE, making him the second youngest person to be diagnosed with the condition. Thomas was the second amateur football player diagnosed with CTE, after Mike Borich, who died at 42. The doctors who performed the autopsy indicated that they found no causal connection between the nascent CTE and Thomas’s suicide. There were no records of Thomas missing any playing time due to concussion, but as a player who played hard and “loved to hit people,” Thomas may have played through concussions and received thousands of subconcussive impacts on the brain.
In October 2010, 17-year-old Nathan Stiles died hours after his high school homecoming football game, where he took a hit that would be the final straw in a series of subconcussive and concussive blows to the head for the highschooler. The CSTE diagnosed him with CTE, making him the youngest reported CTE case to date.
In July, 2011, Colt tight end John Mackey died after several years of deepening symptoms of frontotemporal dementia. BUSM was reported to be planning to examine his brain for signs of CTE. The CSTE found CTE in his brain post-mortem.
In 2012, retired NFL player Junior Seau committed suicide with a gunshot wound to the chest. There was speculation that he suffered brain damage due to CTE. Seau’s family donated his brain tissue to the National Institute of Neurological Disorders and Stroke. On January 10, 2013, the brain pathology report was revealed and Seau did have evidence of CTE.
The NFL has taken measures to help prevent CTE. As of July 2011, the NFL has changed its return-to-play rules. The number of contact practices has been reduced, based on the recent collective bargaining agreement.
In 2012, some four thousand former NFL players “joined civil lawsuits against the League, seeking damages over the League’s failure to protect players from concussions, according to Judy Battista of the [New York] Times“.
On August 30, 2013, the NFL reached a $765 million settlement with the former NFL players over the head injuries. The settlement created a $675 million compensation fund from which former NFL players can collect from depending on the extent of their conditions. Severe conditions such as Lou Gehrig’s disease and postmortem diagnosed chronic traumatic encephalopathy would be entitled to payouts as high as $5 million. From the remainder of the settlement, $75 million will be used for medical exams, and $10 million will be used for research and education. However, in January, 2014, U.S. District Judge Anita B. Brody refused to accept the agreed settlement because “the money wouldn’t adequately compensate the nearly 20,000 men not named in the suit”.
Bernie Kosar, who sustained several concussions during his twelve-year NFL career and has shown symptoms of CTE, has submitted himself to an experimental treatment program led by Dr. Rick Sponaugle of Florida that has alleviated many of his symptoms. The program, the details of which are proprietary, involves increasing blood flow to damaged portions of the brain. He has spoken out in public about his successes with the treatment in the hopes that others who suffer from the disease can find relief and avoid the fates of Duerson and Seau, both of whom were personal friends of Kosar’s. The efficacy of Dr. Sponaugle’s treatment has not been validated through any published clinical trials or other validated scientific process, nor has this treatment been supported by any reputable medical group conducting research into CTE.
League of Denial: The NFL’s Concussion Crisis | PBS America
Published on Oct 22, 2013
League of Denial: The NFL’s Concussion Crisis – premieres in the UK at 9pm, Thursday 28 November on PBS America (Virgin Media 243 | Sky 534 | pbsamerica.co.uk)
Gridiron football is America’s great national sport, offering a gladiatorial spectacle for millions of fans. But what long-term health risks do the players face?
At the top level, American Football is a huge commercial operation, with the National Football League presiding over a competition whose leading players command eight-figure salaries. But the NFL is currently under assault as thousands of former players are claiming that the league has covered up football’s connection to long-term brain injuries.
Award-winning journalists Steve Fainaru and Mark Fainaru-Wada investigate allegations that the league worked to refute scientific evidence that the violent collisions at the heart of the game are linked to early onset dementia and potentially catastrophic brain damage.
Featured cases include former Pittsburgh Steelers star Mike Webster, who died in 2002 at the age of 50. Webster had chronic traumatic encephalopathy, a devastating neurological disorder that was almost certainly contracted during the Hall of Famer’s 17-year career. But Webster’s case may prove to be merely the tip of the iceberg. With thousands of lawsuits having been filed by former players, the very future of the game may be at risk.
LEAGUE OF DENIAL: NFL’s Concussion Crisis (ESPN Outside The Lines) (Full Episode HD)
Published on Oct 2, 2013
Mark Fainaru-Wada and Steve Fainaru discuss their new book with Bob Ley on OTL, in which they say the NFL used its power to deny a link between playing football and brain damage.
The National Football League conducted a two-decade campaign to deny a growing body of scientific research that showed a link between playing football and brain damage, according to a new book co-authored by a pair of ESPN investigative reporters.
The book, “League of Denial: The NFL, Concussions and the Battle for Truth,” reports that the NFL used its power and resources to discredit independent scientists and their work; that the league cited research data that minimized the dangers of concussions while emphasizing the league’s own flawed research; and that league executives employed an aggressive public relations strategy designed to keep the public unaware of what league executives really knew about the effects of playing the game.
From CBS News:
With chronic traumatic encephalopathy (CTE) and concussions a hot topic in the NFL, a new study is adding evidence to the claims that repeated blows to the head may leave lasting effects in athletes.
Brain imaging scans of retired football players have showed unusual activity linked to how many times they had a head injury during their careers. The new study, published in Scientific Reports on Oct. 17, reports that these players may develop small neurological defects that doctors might not see with regular tests.
“The critical fact is that the level of brain abnormality correlates strongly with the measure of head impacts of great enough severity to warrant being taken out of play,” lead study author Dr. Adam Hampshire, from the department of medicine at Imperial College London, said in a press release. “This means that it is highly likely that damage caused by blows to the head accumulate towards an executive impairment in later life.”
The study looked at 13 former NFL players who said they were suffering from neurological problems likely due to their time on the field. They were compared to 60 healthy volunteers.
Participants were told to rearrange colored balls in a series of tubes in as few moves as possible. During the task, their brains were monitored through a functional magnetic resonance imaging (fMRI) scan.
The NFL group performed slightly worse on the test than the control group. More troubling, the NFL group’s brain scans shown unusual patterns of brain activity in their frontal lobe. The frontal lobe controls higher-order brain activity that regulates for cognitive or thought processes. The researchers believe that the changes observed may have an effect on the NFL players’ abilities to plan and organize.
The differences were so stark that a computer program was able to determine with 90 percent accuracy which brain belonged to a former NFL player based on the frontal lobe activation patterns.
“The NFL alumni showed some of the most pronounced abnormalities in brain activity that I have ever seen, and I have processed a lot of patient data sets in the past,” Hampshire said.
The researchers suggests the data shows that the brain may compensate for damage by having other areas work harder to make up for all the deficits. They called for more research on players, especially over the course of different seasons.
They add their work may be relevant to others outside of athletics who have suffered repeated head injuries.
An increasing amount of research has looked into how head blows sustained during football may affect the brain long-term.
Ex-NFL players were shown in a 2012 study to be especially vulnerable to deaths from degenerative brain diseases. The death rate from Alzheimer’s, Parkinson’s and Lou Gehrig’s disease combined was three times higher for the former players than the general population. Former players are also more likely to have higher rates of depression and cognitive problems.
Then there’s CTE, a progressive degenerative brain disease that often occurs in people who have had multiple concussions or other brain trauma. Symptoms can include changes in mood including depression, problems with cognition or behavior like dementia and difficulties with motor abilities. It can only be diagnosed after death.
Brain autopsies on former football players, wrestlers, hockey players, boxers, and military combat veterans revealed that the majority of them that who had repeated head trauma during their careers had evidence of CTE. Junior Seau, the former NFL linebacker who committed suicide in April 2012, was diagnosed with CTE postmortem. Interviews with family members of patients confirmed to have CTE after death revealed that their loved ones experienced symptoms that could be linked to CTE — including “explosive” and out of control behavior, depression and memory problems — before they passed away.
The NFL agreed to a $765 million settlement for the concussion lawsuits that more than 4,000 former players had brought forth.
A promising study in January on the brains of five retired NFL players may have found a way to diagnose CTE before the death of the person. The researchers used a PET scan and a chemical marker to look for abnormal tau proteins in their brain that normally signify Alzheimer’s. But, the research is still preliminary.
Physiologist Damir Janigro of the Cleveland Clinic in Ohio pointed out that the new study had limitations, including the researchers did not compare the brains of injured NFL players to those of healthy players. It also did not look at brain function of players before their injuries. Janigro said the findings may suggest that these NFL players always had more brain function in their frontal lobe to begin with, regardless if they were hit or not.
“It could be why they are good football players,” he said to LiveScience.
Despite greater awareness around head injuries and stricter guidelines before players can return to the field, many NFL players state that they would try to hide concussion symptoms even if they know it may mean bad news for their brains in the long run. The Associated Press revealed that 23 out of 44 NFL players would try to conceal a possible concussion rather than leave the game.
“The bottom line is: You have to be able to put food on the table. No one’s going to sign or want a guy who can’t stay healthy,” Jacksonville Jaguars running back Maurice Jones-Drew said.” I know there will be a day when I’m going to have trouble walking. I realize that,” Jones-Drew said. “But this is what I signed up for. Injuries are part of the game. If you don’t want to get hit, then you shouldn’t be playing.”
Thank you CBS News.
Other Professional Athletes Diagnosed With CTE