Soccer field

Brain trauma spreads to the football field

Chronic traumatic encephalopathy, the degenerative disease of the brain linked to repeated blows to the head, was posthumously found in a 29-year-old former footballer, the strongest indication to date that the disease is not limited to athletes who played sports known to have violent collisions. , like football and boxing.

Researchers at Boston University and the VA Boston Healthcare System, who have diagnosed dozens of cases of CTE, said the player, Patrick Grange from Albuquerque, was the first named football player to have a CTE. On a four-point severity scale, his illness was considered stage 2.

Football is a physical game, but rarely violent. Players sometimes collide or fall to the ground, but the most repeated hits to the head can come from directing a ball into the air – to redirect it on purpose – in games and practices.

Grange, who died in April 2012 after suffering from amyotrophic lateral sclerosis, was especially proud of his ability to lead the ball, said his parents, Mike and Michele. They remembered him as a 3-year-old incessantly throwing a soccer ball in the air and aiming it at a net, a skill that he continued to practice and display in college and in schools. top amateur and semi-professional leagues in their quest to play Major League Soccer.

Credit…Ann McKee, MD, VA Boston Health System / Boston University School of Medicine

Grange suffered some memorable concussions, his parents said – falling hard as a toddler, being knocked unconscious in a high school game and having once received 17 stitches to his head after a crash on the field at the ‘university.

“He had very significant damage to the frontal lobe,” said Dr. Ann McKee, the neuropathologist who performed the brain exam on Grange. “We have seen other athletes in their twenties with this level of condition, but they have generally been football players.”

Grange’s brain damage, McKee said, corresponded to the part of his head that Grange would have used for the headers. But she cautioned against general conclusions.

“We can’t say for sure that the ball header caused his condition in this case,” McKee said. “But it’s worth noting that he was a frequent header of the ball and he developed this disease. I’m not sure we can go any further than that.

CTE is believed to be caused by repeated blows to the head – even barely noticeable sub-concussion blows. Once considered unique to boxers, it has been diagnosed over the past decade in dozens of deceased soccer players and several hockey players. In December, it was first found in a baseball player’s home. Symptoms can include depression, memory loss, impaired impulse control, and possibly progressive dementia, the scientists said.

Researchers at Boston University have also discovered a severe case of CTE in 77-year-old former Australian rugby player Barry Taylor, known by his nickname, Tizza. A fierce type, he played competitive rugby for 19 years, including 235 games for Manly Rugby Union, an Australian professional team near Sydney.

While brain research involving rugby players is still in its infancy – in part due to the sport’s general lack of popularity in the United States, where much of the research takes place – Taylor’s state may not come as a surprise. Although rugby players do not wear helmets, their matches, like those of American football, are filled with crashes, many of which involve the head.

Taylor’s family noticed an increase in cognitive problems when he was in his 50s. Within a decade, Taylor was suffering from severe dementia. He passed away in April.

“At one point I took him for a walk and got a lot of monosyllabic responses,” Taylor’s son Steven said. “I said, ‘What’s your name, mate? He looked at me and just shrugged. This is the point at which it has come. He didn’t even know who he was.

McKee discovered that Taylor’s brain was extraordinarily shrunken and damaged. His disease was diagnosed as severe stage 4 CTE

“It was, in many ways, a very classic case – the tear of the septum pellucidum and the lining of the ventricles, and the atrophy of the central structures of the brain,” McKee said.

“And then under the microscope he had this huge buildup of abnormal tau,” she added, referring to a symptomatic protein, “and no evidence of any other disorder. It was a pure case of CTE. .

Credit…Mark Holm for the New York Times

The diagnosis was a relief for Taylor’s family, including her daughter, Jennifer, and son. But the regret is that the disease could have been prevented.

“We both talked about it and we had this great relief,” said Steven Taylor. “It’s not genetic. But there was a lot of sadness, knowing it was preventable. It was a big mess, a big shame, knowing that the last 20 years didn’t have to be like this.

The results are part of an updated version of filmmaker Steve James’ 2012 documentary “Head Games”. The updated film, titled “Head Games: The Global Concussion Crisis,” will debut Thursday at NYU Langone Medical Center.

Dr Erin Bigler, professor of psychology and neuroscience and director of the Brigham Young Magnetic Resonance Imaging Research Center, said he was not surprised to learn that CTE was found in a football player .

“The brain is a very delicate organ, and it can probably take some injuries, but the whole problem of repeated injuries is a very different circumstance,” he said. “When he moves, he moves with his 200 billion brain cells. And these cells are, in a way, mechanically deformed, some more than others, which gives you an idea of ​​what is going on with these collisions.

Bigler said he would not recommend players, especially young people, to direct the ball on a regular basis. The brain is not fully developed until around the age of 25, he said, making it more vulnerable to injury.

Some youth football organizations have cautioned against practicing the header until players reach a certain age, usually between 10 and 14 years old. Some scientists think these ages are somewhat arbitrary, but understand that parents want to know if their children should be allowed to run soccer balls.

“The harsh reality is that the data does not exist to answer this question,” said Dr. Michael L. Lipton, neuroscientist and neuroradiologist at the Albert Einstein College of Medicine at Yeshiva University, who studies the effects of cap. “We are really in very uncharted territory. So what should I do with my child? It basically becomes the kind of risk benefit assessment that we have to do all the time in life. “

Credit…Ann McKee, MD, VA Boston Health System / Boston University School of Medicine

Last year, the journal Radiology published the results of a study by Lipton and others of 39 amateur adult soccer players, with a median age of 31, who had played soccer since childhood. He concluded that “the head is associated with abnormal white matter microstructure and poorer neurocognitive performance.”

Lipton said on Wednesday there was likely a reasonable threshold below which the cap could cause few problems.

“Above a certain level, the course is probably not good for anyone,” he said.

After the death in 2002 of Jeff Astle, 59, a longtime England Premier League player who exhibited symptoms of dementia in his later years, a coroner determined that directing the ball likely resulted in the damage found in his brain. The term CTE was not widely used at the time, but scientists believe Astle probably had it.

Grange was a longtime football player who played in high school and college in Illinois-Chicago and New Mexico. He played for the Chicago franchise of the Premier Development League, a testing ground for future professional players, and in a few semi-professional leagues. He coached and played at an indoor soccer complex in Albuquerque, his hometown.

Grange was 27 when he was discovered to have ALS, a degenerative disease of the nervous system sometimes referred to as Lou Gehrig’s disease. Most people with ALS are very old or older, with an average age of 55 at the time of diagnosis, according to the ALS Association.

Grange’s symptoms started with a sore calf. He soon had difficulty walking and was diagnosed with ALS. Barn had to use a wheelchair within six months. The paralysis soon made him unable to eat. He died 17 months after being diagnosed with ALS.

McKee believes Grange’s brain damage was at the heart of his ALS

“We think the triggering factor in her case was most likely the trauma,” McKee said. “First of all, he was absurdly young when he developed this disease. And he had considerable evidence of this trauma-induced tauopathy, or CTE “

Looking back, Grange’s family said he had symptoms of CTE from high school. He had trouble balancing a checkbook. He did not understand the repercussions of failing at school. He once left for Seattle to try out a soccer team and returned to find that he had been fired from his server tables because he had never requested time off. Grange battled depression in the years leading up to his diagnosis, his parents said.

When he died, the Granges got a call from Boston University, asking for his brain. It was painful to hear that their son had CTE, but it brought some semblance of relief and peace. Like the medics, they can’t be sure their son’s death was precipitated by football, but they wish they had discouraged his habit of directing the ball.

“In all the parks you go through, the kids are playing football,” said Michele Grange. “And they do headers. And that really bothers me. When I see little children playing football, even my grandson, it reminds me of better days. But on the other hand, it makes you think of the consequences. And I hope these kids and their parents will make sure they take care of their heads.