CTE

Zachary Matthews

Robin DeRosa

Comp.

05/05/16

CTE

Chronic Traumatic Encephalopathy “CTE” is a newly discovered disease that is found in the brain of an individual who has sustained a traumatic brain injury or repetitive head contact of several years. CTE has affected the lives of many. From famous athletes, to the heroes who serve our country. Not only does it affect them individually, but also their families as a whole. Some may ask what CTE is. This newly discovered disease has been known to create a protein known as tau. What is tau you may ask? Tau is a brown stain in the brains blood vessels that interrupts the normal functions of the cells and eventually ends up killing them. The physical damage that the brain obtains is reduction in size, and the degeneration of the frontal and temporal cortexes and the medial temporal lobe. “Is marked by progressive degeneration of brain tissue. Symptoms include memory loss, confusion, aggression, depression and eventually progressive dementia.” Sean Conboy.

The incredible doctor that found this disease is Dr. Bennet Omalu. Omalu is a forensic pathologist that found the first signs of CTE in the deceased Pittsburg Steelers center Mike Webster.  Webster had died suddenly and unexpectedly, following years of struggling with cognitive and intellectual impairment, destitution, mood disorders, depression, drug abuse, and suicide attempts. Even though Webster’s brain looked normal during the autopsy, Omalu conducted independent and self-financed tissue analyses. He assumed Webster suffered from “dementia pugilistica”, a dementia encouraged by frequent blows to the head. Omalu found large accumulations of tau protein in Webster’s brain, affecting mood, emotions, and executive functions similar to the way clumps of beta-amyloid protein contribute to Alzheimer’s disease.

In summer 2007, Omalu partnered with neurosurgeon Julian Bailes and presented their findings to NFL Commissioner Roger Goodell at a league-wide concussion conference. Bailes later announced the research was “dismissed.” The NFL’s MTBI committee chair, Dr. Ira Casson, told the press: “In my opinion, the only scientifically valid evidence of a chronic encephalopathy in athletes is in boxers and in some Steeplechase jockeys.” Bailes then also stated “It gets old to diagnose a disease after someone’s dead – you can’t intervene or help them”. The NFL did not publicly acknowledge the link between concussions sustained in football and CTE until December 2009, seven years after Omalu’s discovery. Omalu has also discovered CTE in the brains of military veterans, publishing the first documented case in a November 2011 article.

Research indicates that there are 4 stages of the illness.  In Stage 1, isolated spots of tau build up mostly around the frontal lobe of the brain.  An individual would normally notice no symptoms at this stage.  In Stage 2, symptoms such as rage, impulsivity and depression begin to appear as defective tau protein affects more nerve cells in the brain’s frontal lobes. By Stage 3, an individual is experiencing confusion and memory loss as the tau deposits expand from the frontal lobe to the temporal lobe of the brain.  By the time an individual reaches Stage 4, they are suffering from advanced dementia.  It is at this stage that the brain becomes deformed and brittle, and cognitive function is severely limited. Once at the final stage of the CTE process, tau deposits have overwhelmed the individual’s brain, killing many nerve cells and shrinking the brain to half its normal size.  At this point, the victim no longer has any memory and will not remember even their closest family members.

CTE is diagnosed in individuals who have a long history of past of traumatic head trauma.  A study run by members of the Department of Veterans Affairs and Boston University discovered that testing done on NFL players posthumously revealed that 79% of the players had this disease. Jason M. Breslow states “In total, the lab has found CTE in the brain tissue in 131 out of 165 individuals who, before their deaths, played football either professionally, semi-professional, in college or in high school.” Now this is a pretty scary number and the worst part about CTE is that the patient has to be dead for it to be looked at.  “Forty percent of those who tested positive were the offensive and defensive linemen who come into contact with one another on every play of a game….” James M. Breslow. The amount of contact needed to cause this disease differs for every patient because everyone has different bone densities. The patient may have been a NFL running back that got several concussions, or it could happen to a solider that is around the blast of an IED “Improvised Explosive Device”. CTE is a scary illness because the person with the disease is normally depressed, violent and confused. Also, if the patient has PTSD “Post Traumatic Stress Disorder” this could intensify a breakdown and make them self a threat to not only his/her self, but also the community as a whole.

There has been a strangely large amount of NFL players that have committed suicide in hopes that their brains are examined and used as a helpful resource in furthering the studies on this evil disease CTE. “The hard-hitting safety killed himself at 44. Waters told The Philadelphia Inquirer of the concussions in his career: “I think I lost count at 15.” Andre Waters stopped counting at 15 concussions. The real question is how many did this man actually sustain during his career? There have also been other cases like Junior Seau, Ray Easterling and Jovan Belcher.  Each of these former NFL players ultimately had the same fate as Andre Waters by killing themselves due to the effects of CTE.

CTE is found in people that are often extremely familiar with head contact. With that being said there are many professional sports that allow the players to deal out a large variety of hits. This gives the sport more entertainment not only for the players, but for the fans that are paying a lot of money. These players don’t just go out and play the sport because they love it that much; they are making millions of dollars to sacrifice their bodies and believe that it is all worth it for the money they are getting paid.  If you look at Boxing, CTE has been a commonly known illness for the players because they are getting punched in the head at practice. They receive different brain rattling blows in a fight that may even result in a knock out.

Just this month was the horrible death of WWE wrestler and entertainer Chyna. She wrestled in the WWE starting February 16, 1997 until she died. She was also a model, bodybuilder, adult entertainer and actress. She just recently overdosed accidently on a prescribed sleeping pills and tranquilizers. Right before Chyna’s death she said that even though the WWE is scripted, not all the hits are fake and that they do receive head trauma frequently. She asked to have her brain donated to science after her death to be examined for CTE.

There are many symptoms to CTE. These symptoms come years before it has even developed. Some of these symptoms develop just like a concussion would however CTE is a much more intense and life threating ordeal. With a concussion the brain swells and may bleed creating pressure. Said by the Mayo Clinic Staff “However, because CTE is associated with recurrent concussions, it can be prevented.” Some of the ways that studies have shown to prevent future brain damage is by cutting back on activities, getting plenty of rest, reduce physical activity, avoid too much computer time, and get plenty of sleep. Once the concussion is gone return to activities gradually, with guidance from your doctor. You must avoid drinking alcohol and take only prescribed medication. A patient may want to write down tasks or activities that they want to do to help them remember later on in the day. For someone that has a job it is best to ease back into work and most definitely consult others before making major decisions. If these procedures are not followed than the patient put themselves at a higher risk for CTE in the future.

When most people have a concussion and are told to not do anything, they take it as a joke. Although they know it’s medically important for them to be properly diagnosed with a concussion, they do not want to take the right steps for preventing CTE which could affect them later in life. An athlete is trained to play through most injuries and in most cases with no long term effects. The difference being a player who continues to play while suffering the effects of a concussion increase the risks of this disease. CTE is triggered over time from serious head contact and not taking care of the brain after the damage is done is the leading cause of this disease. If you do not take the right precautions to prevent CTE the higher the risks are to be diagnosed.

New and improved technologies are coming out for football helmets that may have found the answers to concussions leading to CTE. These new helmets are equipped with concussion sensors that are located on the forehead, temples and back of the head. This is because these are the parts of the head that are repeatedly hit over the course of a season. These sensors come packed with a hand held monitor. The monitor is powered by battery and comes up with every players’ names when turned on. Also there is a display of a helmet that has the different locations of the sensors. The way that they work together is when the player gets into a head to head collision hard enough to trigger the sensor, a sensor is set off.  The hand held monitor vibrates indicating that the contact was packed with too much force. The light will flash where the player got hit. The trainer is then notified and there is an on field evaluation given. Even if the player passes the concussion test given by the trainer, they always have the final say as to whether or not to keep the individual out of the game.

I know this because it happened to me. The trainer and coach may also decide whether the player is able to take a more powerful contact. In this case the trainer and coach must contact the player’s parents if they are under the age of 18. For example if you are in high school and you think you can take a harder hit, your trainer and coach will decide to either keep your sensor at the same level, or change it to a higher setting. The biggest question that this brings up is “Is it safe”? What I mean by this, is are these coaches and trainers qualified to change the levels and are they changing these sensors for the benefit of the player or for the organization?

In new studies 5 former NFL players were tested for having CTE. The new study involved injecting the retired players with a radioactive liquid called FDDNP.  Previously, CTE could be diagnosed only posthumously by staining cross-sections of brain tissue with an amino acid called AT8. Under microscopic evaluation, the stains reveal the distinct neurofibrillary tangles of tau. In this new study, by the Semel Institute for Neuroscience and Human Behavior at UCLA, the players were injected with a radioactive compound called FDDNP. The compound acts as a tracer by binding to the tau proteins associated with chronic traumatic encephalopathy. The tracer appears in varying densities — from blue (low) to red (high) — in a routine positron emission tomography scan.”

“Stern said it is important to develop a test for CTE for living patients because the sooner the disease is diagnosed; the sooner players can receive treatment” Michael O’Keeffe. This couldn’t have been said better because there are millions of players in the world that are getting concussions every day and they receive no treatment other than sitting in a dark room and not being able to watch TV. For a person with CTE you feel trapped mentally and have no hope for the future other than when you pass because it is at that point your brain can finally be examined.

CTE is a progressive, degenerative brain disease, for which there currently is no treatment.  Because we now know for certain that it is associated with recurrent concussions, it can and should be prevented.  Until a treatment can be discovered to treat this disease, future research needs to continue to be developed.  Children and adults alike are going to continue with the many things that cause this devastating disease, making it all the more important for a cure to be found.

 

 

 

Work Cited

 

http://www.pbs.org/wgbh/frontline/article/new-87-deceased-nfl-players-test-positive-for-brain-disease/, Jason M. Breslow, September 18,2015

This article is on CTE. CTE is a new found disease found in the brain of one that has had a traumatic brain injury, or repetitive contact over the course of years. The study in the article was ran by members of the Department of Veterans Affairs and Boston University. The test was on NFL players after they have died and even studies on the brain of all the current NFL players. Also they say 79% of all players have this disease.

“In total, the lab has found CTE in the brain tissue in 131 out of 165 individuals who, before their deaths, played football either professionally, semi-professionally, in college or in high school.”

“Researchers with the Department of Veterans Affairs and Boston University have now identified the degenerative disease known as chronic traumatic encephalopathy, or CTE, in 96 percent of NFL players that they’ve examined and in 79 percent of all football players.”

“Forty percent of those who tested positive were the offensive and defensive linemen who come into contact with one another on every play of a game, according to numbers shared by the brain bank with FRONTLINE.”

In its 2015 Health & Safety Report, the NFL said that concussions in regular season games fell 35 percent over the past two seasons, from 173 in 2012 to 112 last season. A separate analysis by FRONTLINE that factors in concussions reported by teams during the preseason and the playoffs shows a smaller decrease of 28 percent.

What they are trying to do is eliminate concussions from the game and that is never going to happen.

http://www.nytimes.com/2016/03/15/sports/football/nfl-official-affirms-link-with-cte.html?_r=0 , Ken Belson, March 14, 2016

This article from the NY Times is on an official that confirmed that there is a relation between CTE and the contact sport football. “N.F.L. Official Affirms Link Between Playing Football and C.T.E.” At a meeting that the NFL had Jeff Miller the NFL Senior Vice President for Health and Safety Policy was ask by Rep. Jan Schakowsky if there was a link between Football and The CTE Brain disorder. He found out that students from BC found CTE in the desist brains of NFL players. For years the NFL denied any relation between the two, but it’s obvious that it messes with your mind..

“The answer to that is certainly yes.” Said miller

“We know the answers will come as this field of study continues to advance.”

“Quite obvious from the medical research that’s been done that concussions can lead to long-term problems.”

The long-term effects are awful. Not only can a player get CTE, they can get Dementia leaving them not even remembering their own families.

 

http://www.nytimes.com/interactive/2016/02/03/sports/football/nfl-brain-disease-cte-concussions.html?_r=0 ,  Gene J. Puskar, Feb 3, 2016

This is another NY Times article on all of the players that have suffered from CTE and what has happened to them in their life. They all struggle from miserable headaches that leave you bone crippling. Most of these player end up overdosing or killing them self’s because they are trapped in their head.

“The Hall of Fame linebacker shot himself in the chest at 43”

“McHale, an N.F.L. lineman from 1987 to 1995, died at 45 from an accidental combination of oxycodone and cocaine. According to his widow, Lisa, he developed such chronic pain in his shoulders and other joints that he began taking improperly large doses of the painkiller OxyContin, which exacerbated his lethargy and depression and led him to take cocaine occasionally to offset those effects”

“The hard-hitting safety killed himself at 44. Waters told The Philadelphia Inquirer of the concussions in his career: “I think I lost count at 15.”

I agree that all these players are people trapped inside your own head. You can’t describe the feeling of it, but you want to tell someone what it’s like.

http://www.nydailynews.com/sports/football/researcher-5-years-cte-test-living-article-1.2519688 , Michael o’keeffe, Feb 3, 2016.

“Stern said it is important to develop a test for CTE for living patients because the sooner the disease is diagnoses, the sooner players can receive treatment.”

“The brain goes through incredible maturation between the ages of 9 and 12,” Stern said. “If normal development is hurt because of repeated hits to the head that might lead to later life problems.”

“The research will include a control group of 60 men who did not play football or other collision sports. All of the participants will be in their 40s to 70s. The players and the control group will be screened again in three years.”

I believe that if we get this new CTE diagnosis that there is going to be no football. Once diagnosed with the disorder the individual will probably never be allowed to play again. In this case very few would get past 8-12 making the NFL not really anything.

http://www.pbs.org/wgbh/frontline/article/the-four-stages-of-cte/ , Evan Wexler, October 8, 2013

This slide show shows all the stages that lead up to chronic CTE. Not only does it explain the stages, but it also shows pictures of what the brain looks like at these times in the process.

“Sense then, researchers at Boston University have found the disease in 50 additional players, one as young as 17.”

“CTE causes a protein that is known as tau to form around the brains blood vessels, interrupting normal functioning and eventually killing verve cells.”

“By stage 4, tau deposits have overwhelmed the brain, killing many nerve cells and shrinking the brain to half its size.”

The difference in the size of a normal brain and one that has suffered from CTE are traumatizing. These pictures really make you think what goes on in the head after a big hit in a sports game.

http://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/basics/treatment/con-20113581, Mayo Clinic Staff, November 11, 2014

This article is sharing information on how to treat the brain to prevent CTE. There are a lot of different approaches to limit the stress on the patient’s brain so that they can get going back in their normal life.

“CTE is a progressive, degenerative brain disease for which there is no treatment. “

“If you had a concussion recently, you will not have developed CTE. However, you should take care of yourself until you have fully recovered in order to prevent additional injury. If your symptoms return at any point:”

Cut back on activities

Get plenty of rest

Reduce physical activity

Avoid too much computer time

Get plenty of sleep

Return to activities gradually, with guidance from your doctor

Avoid drinking alcohol and take only prescribed medication

Write things down or limit tasks, as needed

Ease back into work

Consult others before making major decisions

“However, because CTE is associated with recurrent concussions, it can be prevented.”

It’s crazy that there is not one treatment for people with CTE. Having major brain injuries are painful and to have one for life is most certainly some to try to prevent. This article has the basic steps needed to prevent CTE symptoms the best ways possible.

 

http://www.tsn.ca/a-possible-breakthrough-on-testing-cte-1.210725 , February 19, 2015, Rick Westhead

“Until now, chronic traumatic encephalopathy, or CTE, could only be detected during autopsies, after doctors sliced the brain of a deceased patient into thin strips and examined it under a microscope.”

“Concussions and long-term brain injuries have become hot-button topics throughout pro sports, particularly in pro football and hockey. Researchers have found CTE in the brains of former NHL players Bob Probert, Derek Boogaard, Reggie Fleming and Rick Martin.”

“It gets old to diagnose a disease after someone’s dead – you can’t intervene or help them,” Bailes said”

It must be really annoying knowing that something is wrong with someone, but without the right technology it’s not possible.

http://www.wired.com/2013/01/pet-scan-cte-test/ , Sean Conboy, January 23,13

“Is marked by progressive degeneration of brain tissue. Symptoms include memory loss, confusion, aggression, depression and eventually progressive dementia.”

” Previously, CTE could be diagnosed only posthumously by staining cross-sections of brain tissue with an amino acid called AT8. Under microscopic evaluation, the stains reveal the distinct neurofibrillary tangles of tau. In this new study, by the Semel Institute for Neuroscience and Human Behavior at UCLA, five former NFL players were injected with a radioactive compound called FDDNP. The compound acts as a tracer by binding to the tau proteins associated with chronic traumatic encephalopathy. The tracer appears in varying densities — from blue (low) to red (high) — in a routine positron emission tomography scan.”

“After decades of blissful ignorance, science might be on the verge of forcing athletes, from PeeWee players to professional superstars, to face something they’ve been conditioned to ignore: their own mortality.”

Even though these football players are getting constant contact everyday to the head. They don’t care. They are making millions of dollars to sacrifice their bodies. I would give up my brain in 30-40 years for millions now.

http://stm.sciencemag.org/content/scitransmed/4/134/134ra60.full , see site for all writers, May 16, 2012

“Case 1, a 45-year-old male U.S. military veteran with a single close-range IED blast exposure, experienced a state of disorientation without loss of consciousness that persisted for ~30 min after blast exposure. He subsequently developed headaches, irritability, difficulty sleeping and concentrating, and depression that continued until his death 2 years later from a ruptured basilar aneurysm. His medical history is notable for a remote history of concussion associated with a motor vehicle accident at age 8 years.”

“Individuals exposed to explosive blast are at increased risk for traumatic brain injury (TBI)”

“We developed a blast neurotrauma mouse model that recapitulated CTE-linked neuropathology in wild-type C57BL/6 mice 2 weeks after exposure to a single blast. Blast-exposed mice demonstrated phosphorylated tauopathy, myelinated axonopathy, microvasculopathy, chronic neuroinflammation, and neurodegeneration in the absence of macroscopic tissue damage or hemorrhage.”

It’s horrible that ied’s and the blasts from grenades can cripple someone. Some of these men didn’t even get hit, they got the force off the blast.