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Chronic Traumatic Encephalopathy (CTE)

Chronic Traumatic Encephalopathy

In the case of Junior Seau, who committed suicide in 2009, physicians and researchers believe repeated blows to the head resulted in a condition known as chronic traumatic encephalopathy (CTE), a progressive, degenerative brain disease. Like most brain changes, CTE has been linked with depression.

"It is usually not possible to determine whether the injury and subsequent decline in brain function directly causes depression or whether the person, recognizing a decline in function, starts becoming depressed as he or she grapples with lessened abilities," Dr. Friedman says. "Many of these patients have sustained damage in the frontal lobes, which alters their personalities and increases their impulsivity, leading to regretted actions."

Finding answers

There has been an increase in research since the identification of CTE in former NFL players like Seau.

"Obviously, this problem affects football players who played at lesser levels as well. The same syndrome, formerly called dementia pugilistica or the 'punch drunk' syndrome, was well known but not studied much," Dr. Friedman says. "It is a very interesting disorder in that repeated blows to the brain produce a progressive degeneration in the brain that may not begin for one or more decades after the blows stop."

Researchers from Harvard School of Medicine have been studying young professional soccer players who have no symptoms of brain injury. The results of their work, published last month in Neurology Today indicate that there are changes in white matter integrity in their brains that is consistent with mild traumatic brain injury, likely due to repeated "heading" of the ball, or passing the ball using only one's head. While the researchers do not yet know what the changes in white matter mean, they claim they are similar to those changes seen in hockey and football players.

Currently, Dr. Friedman says researchers are trying to find risk factors to identify people who are at greater risk and can be advised to avoid sports that are likely to cause the problem. There is also work underway to identify people who are normal now but are going to develop this problem later on. If this is possible, work can be done to try to prevent the damage.

"Probably the most work is on identifying the pathology and working back to try to figure out the mechanism of the damage," Dr. Friendman notes.

Parental supervision

In the meantime, he suggests that parents guide their children away from sports that involve head blows.

"I believe that professional boxing should be banned since the goal is to inflict brain damage," he states. "The issue of football and hockey are much more difficult and, even if heading the ball in soccer is a risk, I can't imagine that the most popular sport in the world will restrict this maneuver."

Butler Hospital has joined the effort, partnering with the Rhode Island Interscholastic League to raise awareness about sports-related brain injury and mental health in the community. In January, players at 30 high school hockey games sported "A Healthy Mind"  stickers on their helmets to send a message about the importance of a healthy mind in sports. The partnership was sparked through the efforts of the family of local professional hockey player Tom Cavanagh, who took his life in 2011.

If you would like more information about brain injury, go to: butler.org/news/RIILPartnership.cfm.

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