Athletes and CTE (9/12/19 newsletter)
We are pleased to have Carleton College students and alumni interning with Concussion Alliance. Intern contributors this week:
Editor: Galen Moller
Contributors: Hannah Kennicott, Galen Moller, and Julian Szieff.
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Parents: the “best line of defense” against concussions
The International Concussion Society recently published an online article, geared towards parents, regarding the importance of recognizing concussion symptoms. The article lists several dangers of mishandled concussions, including increased risk for long-term cognitive impairment and second impact syndrome. There are also a few references to Mayo Clinic’s Concussion Check protocol, which we covered in our blog post.
Erectile dysfunction associated with concussions in former NFL players
A study found an association between concussions suffered while playing in the NFL and low testosterone and erectile dysfunction (ED) later in life. Of the 3,409 former pro football players surveyed by the Harvard T.H. Chan School of Public Health and the Harvard Medical School,18% reported low testosterone, and 22.7% reported ED. This study is part of Harvard’s Football Players Health Study.
“Players reporting the most concussion symptoms had nearly twice the risk of ED as those reporting the fewest symptoms,” according to CNBC. Even players with relatively few concussion symptoms had an increased risk of low testosterone levels, which can contribute to diminished libido, impaired ability to orgasm, and ED. Head trauma injuries to the pituitary gland likely cause low testosterone levels.
The average age of the study participants was 52.5 years old, meaning that concussions were affecting their sexual health decades later. According to the authors, the study results have implications for all those who have experienced a head injury, including civilians, veterans, and participants in “combative and contact sports” such as mixed martial arts, hockey, boxing, and soccer.
Authors Rachel Grashow, PhD, MS et al. suggest that “men with a history of head injury may benefit from discussions with their health care clinicians regarding testosterone deficiency and sexual dysfunction.” The authors add, “treatments for testosterone insufficiency and ED, including testosterone replacement therapy and phosphodiesterase type 5 inhibitors, are generally considered safe and have high efficacy rates.” The study was published in JAMA Neurology.
Note: Our August 29th newsletter covered increased rates of sexual dysfunction among concussed women.
Former professional athletes partner with Harvard to research cannabis for CTE
Last month, former NFL players Calvin Johnson and Rob Sims announced their partnership with Harvard University to research the use of medical marijuana for treating chronic traumatic encephalopathy (CTE) and managing pain. ESPN staff writer Michael Rothstein reports that the athletes made a six-figure donation, with an option for future money, to the International Phytomedicines and Medical Cannabis Institute at Harvard. In exchange, the university will do medical research and run clinical trials for Primitive, Johnson and Sims’ cannabis company, and provide quality assurance for any of the company’s products.
When asked about the motivation behind the partnership Sims spoke of his concerns as a former athlete and said, “I may be walking around with some form of it [CTE]. It’s really about the hope. Just providing hope, improving the game, making the game safer for former players after they are done.”
Urine Analysis may be a better option for anticipating long-term effects of TBI
Purdue University reported on recent research by Acosta et al. that suggests urine analysis could be used to screen for long term health issues following blast-induced traumatic brain injury. The researchers found that even one day after the trauma, some patients’ urine showed elevation in the neurotoxin acrolein, which is already recognized as an “important pathological factor in Parkinson’s disease.” The researchers believe that using this screening method, which is easier than blood tests, they can “improve treatment options earlier and potentially offer better long-term outcomes.” The study was published in Molecular and Cellular Neuroscience.
Supervised exercise helps concussion recovery
An article published on the Medical & Life Sciences News website reviewed a publication by Dr. Michael Popovich et al. that found regular activity and low-intensity exercise in the days following a concussion may aid recovery. In this retrospective study, the patients that entered into a supervised exercise program after sustaining a concussion were able to return to their sport more quickly (~9 days earlier) than those who didn’t. The original study was published in the Clinical Journal of Sport Medicine.
Treatments for testosterone insufficiency and ED
See our article in the sports category; the researchers suggest that “men with a history of head injury may benefit from discussions with their health care clinicians regarding testosterone deficiency and sexual dysfunction.”
The authors add, “treatments for testosterone insufficiency and ED, including testosterone replacement therapy and phosphodiesterase type 5 inhibitors, are generally considered safe and have high efficacy rates.” The study was published in JAMA Neurology.
Veterans & Service Members
Free intensive treatment program for service members and veterans
An article in GiantsWire highlights some of the programs of the UCLA Steve Tisch BrainSPORT program, including Operation Mend, which provides care to service members and veterans with traumatic brain injuries. Operation Mend collaborates with the Wounded Warrior Project to provide an “innovative intensive treatment program for service members and veterans suffering from mild traumatic brain injury and post-traumatic stress disorder.” All the services are free for both service members and their families, including travel and accommodations.
Clinicians should exercise vigilance: discerning between neuropsychiatric disorders and CTE
There is considerable overlap in symptoms between neuropsychiatric disorders (PTSD, some forms of dementia) and the mood/emotional symptoms of chronic traumatic encephalopathy (CTE). In an article in Psychiatric Times, Author Arman Fesharaki-Zadeh, MD, PhD, suggests that clinicians should “exercise vigilance” when assessing a patient, and tests should include “detailed diagnostic neuroimaging such as a brain MRI or PET CT scan using pertinent ligands such as tau ligands, if available.”
According to recent understandings of the clinical manifestations of CTE, patients are typically in their 40s or 50s with newly-developed mood and anxiety problems. Also, the author references a 2013 study that found that younger men who were diagnosed with CTE (after autopsy) had problems with mood, behavior, violence, and disinhibition. One-fourth of the younger men did not have memory problems. Clinicians are advised to check for a history of head trauma.
The Trouble with Migraines: Increased TBI Risk for Patients with Migraines
New research into other medical conditions related or linked to concussion can play a pivotal role in understanding and preventing concussions. Researchers Qing-Rui Wang et al. recently published a paper in Global Health Research BMJ Open, exploring the connection between migraines and TBI. They found that “TBI developed in 3.74% (272) of the patients with migraine and in 2.74% (797) of the non-migraine patients.” Patients with migraines are 78% more likely to develop a brain injury, and this connection is present in mild, moderate, and severe TBI.
This study found that people with migraines had an increased risk of TBI due to other medical issues as well. Medical conditions such as alcohol-attributed disease, mental health disorders, and diabetes were shown to increase the risk of TBI for people with migraines. Researchers note that this study may be limited by misdiagnosis and lack of data about how the TBI occurred. These researchers hope that with better migraine treatment options, this risk decreases.
Females at greater risk for a neck injury along with a concussion
A study published in the Journal of Women’s Health found that females obtain neck injury with concussion at a significantly higher rate than males do. The authors Mitchell Sutton et al. looked at all patients in Ontario who were visiting the ER with their first concussion. The study concludes with a call for increased consideration of a possible neck injury in females with concussions, particularly as females are “most at risk for persistent symptoms.”
Otherwise healthy student develops severe brain atrophy and blood clot due to B12 deficiency
Dr. Siobhan Deshauer wrote an article for MedPage Today summarizing a teaching case study published in The Canadian Medical Association Journal that highlights how brain health is dependent on proper diet. In this case study, an active 21-year-old student primarily relied on bread, Cheerios, and French fries for sustenance. He developed a blood clot in his leg despite not having any genetic predispositions. After months passed and he was still experiencing persistent symptoms, doctors performed a brain MRI and found severe brain atrophy and lesions in the white matter. Medical professionals believe that all his diagnoses and symptoms are the result of a severe B12 deficiency.
Helmets / Mouth Guards
NFL uses impact-monitoring mouth guards to better understand how players get hurt
SportTechie reports that the NFL is initiating its pilot programs to collect data for injury prevention by using impact-monitoring mouth guards and cleat-tracking technology. New rules implemented by similar research in the past have likely contributed to a “29% reduction in reported concussions”. The NFL hopes this new pilot program will also help them to protect their players better, potentially through position-specific helmets.
Executive Editor (and Contributor)
Concussion Alliance co-founder Malayka Gormally