The much anticipated December 25th release of the film Concussion starring Will Smith has brought a lot of attention to the topic of Chronic Traumatic Encephalopathy (CTE), and with it, a lot of questions and misconceptions about the disease. Is CTE the result of a single concussion? Does it happen to all players in contact sports? How would I know if I had it? With all the talk and speculation, we felt a need to go back to some of the basics to clarify to the best of our ability, what is currently known and what is not known about this disease that has garnered the attention of everyone from amateur and professional sports associations, to the military, and now Hollywood.
What is Chronic Traumatic Encephalopathy? Is it just a fancy name for what happens after a concussion?
CTE is not a type of concussion or a form of post-concussive syndrome. For more information on concussion, see our prior post on the topic.
CTE is “a disease of the brain found in athletes, military veterans, and others with a history of repetitive head impacts,” as described by Boston University School of Medicine’s Stern Lab, where much research on the disease is conducted. The type of trauma caused by these repetitive impacts to the head has been associated with abnormal tau protein deposits in the brain. The deposits can eventually cause death of the nerve cells and subsequent degeneration of the brain tissue gradually over many years.
What are the symptoms of CTE?
Brain degeneration such as what occurs with CTE is often associated with symptoms and behaviors that may not be noticed until years after head trauma occurs. These include:
- Difficulty with thinking and concentration
- Impulsivity
- Aggression
- Depression
- Parkinson-like symptoms
- Dementia
What exactly causes CTE?
The current belief is that CTE is caused by some type of repetitive brain trauma. The amount of trauma or number of hits to the head at what age that leads to degenerative changes is not known. It could be from multiple concussions, but is also may occur after repetitive hits to the head where no concussive symptoms were present. That said, the exact cause of CTE remains unclear. It is speculated that genetics and other such factors may have an impact on the development of CTE, as not everyone with repetitive hits to the head in their past develops the disease. In addition, recent studies that claim to identify tau in the brain have shown high levels of the protein deposits in individuals with no symptoms of CTE.
If I have some of the symptoms of CTE, does it mean I most likely have it?
No. One of the troubles with diagnosing CTE during life is that its symptoms are not exclusive to CTE. Changes in our ability to think, behavior, and emotions can all be caused by a multitude of other disorders. Currently, the only largely accepted method of diagnosing CTE is via brain autopsy after death. See your physician if you are concerned about any of the symptoms listed above.
The movie Concussion is about football. Is this just a problem in NFL players?
CTE was first recognized as what was called “punch drunk syndrome” in ex-boxers who had suffered years of blows to the head. It is now known that individuals who play a wide variety of sports where impact to the head may occur, along with military personnel subject to blast injuries, all can develop the disease. Soccer, American football, hockey, and boxing are just some of the sports that are paying attention to the risks for CTE and making changes to try to improve the safety of the sports. Research with the VA system also underscores that CTE could become a much more prominent issue in the future for military veterans, and the VA system will need to be able to care for them.
Is there a cure?
Presently, there is no cure for CTE. Because diagnosis is so difficult, researchers do not yet fully understand the exact causes of CTE or have a good understanding of how often it occurs. The next goal of researchers is to develop feasible methods to accurately diagnose CTE during life. Robert Stern, PhD, Boston University professor of neurology and neurosurgery says, “The ability to diagnose CTE while someone is alive is an important next step to allow us to address some of these important issues, as well as develop and test treatment and prevention strategies for the disease.”
For more information on concussion and CTE, contact the Philadelphia Concussion Center at Magee at 215-587-BRAIN (855-587-2724).
