 A new study has scary news about young athletes and brain trauma. Joining us to answer your questions tonight, Dr. Gary Schwartzbauer, who is Director of Neurotrauma at the R. Adams Cowley Shock Trauma Center at the University of Maryland Medical Center. Doctor, thank you for being with us. Tell us about this new study of athletes' brains, particularly young athletes, right? Sure. Thanks. First of all, Jeff, thanks for having me. Thank you. This study, and the significance of it, it was the first time that a large number of younger, mostly athletes, were found to have evidence of something called chronic traumatic encephalopathy. It's a mouthful, and maybe we should talk about what that is, and it really is what the words say, chronic. It's something that is usually associated with something happening over time, traumatic, repetitive head injuries that occur over time, and then encephalopathy. Something with the brain function is not quite right. We have known for some time, actually since 1928, something called dementia pugilistica, punch-drunk, that boxers, when they get older, would not be able to process thinking, would be aggressive, have outbursts of emotion, episodes of depression, suicide. That has been brought up more recently in professional athletes, in particular football, male and female soccer players as well, hockey, et cetera. You name it, the sport, there's probably evidence of this happening. And so there's two components to it, the so-called CTE. One is something you can see from the outside, the way the person thinks. They themselves might not be processing things, remembering things that they used to. They might be aggressive, they might be impulsive, explosive personality, for example. They might not be able to sleep well. These kinds of things are evident to others that are in their life, and maybe even to the person themselves. But the key part of the diagnosis, unfortunately, can't be done until after they die. And at autopsy, they find their brains have a particular kind of staining for something called etal protein. It's the same protein associated with Alzheimer's dementia. It's not the same pattern, so they're not the same thing. But it's not until that autopsy is done that a true definitive diagnosis of CTE is done. Given that, how was this study performed, and what ages were looked at? That's right. And so the key part of this, done by Ann McKee up in Boston, at the Boston VA and Boston University, it was the largest study, 152 patients and brains that they looked at of folks less than 30 years old. The average age that they found was about 22, 23. And about 40% of them, even at this young age, had evidence on this brain sort of tissue staining that nailed down the diagnosis of CTE in these young patients. So it's striking. They can begin early, and they were as young as 14 years old and older within this group. Now they found an association with folks who had this evidence of CTE, played sports longer, roughly three to four years longer than the other folks, brains that were in the study. And they all had evidence of some behavioral issue, whether it was the way that the brains worked, aggression, and in fact to get into this study, and this is a key part of this, does it mean that all young athletes will have evidence of this? Something that was very special about this study, as you can imagine, it's unusual to have a young person who has died for whatever reason. But if they've died under circumstances where the family is concerned that science might want to study their brains, this study came from such a bank of brains. For example, folks who had chronic repetitive injury, whether it was due to sports mostly, most of them are football players, most of them are male, but it could be there were military folks in there from blast injury, et cetera. But the family or loved ones were concerned enough to say, hey, I think you need to study their brains further. So I was going to say, it does seem like things are changing in sports. You think back to the old days of the NFL, and sadly, somebody would get knocked out. They bring them back with some smelling salts and send them back in. Fast forward this year in training camp at the pro level, you saw people, a lot of linemen with helmets on, on top of the helmets, they had additional padding. Can you imagine at all levels of football, there's growing concerns? So given what's been learned in this study, what should happen next? No, it's a great question. And that's what the biggest thing that this study raises. At what point should we be concerned that our young folks are involved in these sports? Mostly contact, but keep in mind that some of the sports like basketball, for example, and even softball that's been found to have evidence of this kind of injury in younger folks. We need to be thinking about this early on. And how can we prevent this, perhaps, and be safer about it? Well, one thing is education. The coaching staff, the medical staff has to be aware of what is a concussion. And the biggest risk is, is repetitive concussions. Concussions doesn't mean that you're knocked out. Has a very simple definition. It's alteration of brain function by a mechanical process. Whether that's a blast, a hit, a fall. And so it could be headache, it could be dizziness, it could be vision changes, double vision. Brain fog is probably the biggest symptoms that folks describe. They can't think as fast as they could. Certainly if you lose consciousness, if you have insomnia, you can't sleep as well as you used to, up and down episodic emotions. These are evidence of concussion, even if someone has not lost consciousness. In fact, in soccer players, they hit their head all the time, but they rarely lose consciousness. But yet, they can have a concussion in the symptoms following. Let me stop you there for a second. I want to remind our viewers if you have a question about brain injury, concussion in sports, give us a call at the number on the screen or send an email to livequestionsatmpt.org. Concussions and the injuries in this study that could lead to CTE, are they the same thing? Like is it an injury, not as severe as a concussion, a bunch of them equal a concussion? How do you think about that? Great question. And so they're basically building blocks to the disease called chronic traumatic encephalopathy, CTE. And so one concussion does not make CTE. It's the fact that repetitive concussions, and especially if a concussion happens within usually a couple of weeks to a month of a primary concussion, the first concussion, in your brain is much more susceptible to worse injury and longer outcome if you have another concussion when you're still recovering from the first. So the key is education to the coaching staff, to the families, the players, to remove that player from the field if they have a concussion. Usually it's 24, 48 hours. If they're starting to feel better, can have a graduated return to play in their guidelines for this. That's one thing. And we were talking a little bit earlier off-camera about the fact that, well, up to 40% of young athletes don't report a concussion to the coach, to the team, even to their families. And so we have to be very vigilant of symptoms from this. Other things, better equipment, for example, helmets. It gets confusing because helmets themselves have different kinds of grading, something called SNEL or NOC SAE, or if the helmet is going to break or lead to a skull fracture. There's another one called Virginia TAC that supposedly prevents concussions with a star rating system. That seems to be the most popular. So look for some of these, but also ask questions about what's the safest equipment, and there's ongoing research about these from several angles. Let's grab a phone call from Baltimore County. This is Rick. Rick, thank you for the call. Go ahead. Yes, thank you for answering. My question is about in vivo diagnostic protocol, which would be that the brain acoustic monitor be enabled to survey the blood profusion in the brain following traumatic injury. Rick, thank you. That was over my head. I hope it was almost over mine, but Rick, thank you again. That's a great question because we're stuck now with CTE being something that happens on or basically the diagnosis is after they die, right? That's too late. We want to catch it as it's happening or before it happens. And so MRI, studies such as you're talking about acoustic monitoring, markers, meaning something that is in the cerebral spinal fluid that floats around the brain or in the blood. Folks are actively researching that, but nothing as of yet. There's a cultural issue in sports. If you're an athlete, you want to play. You said 40% go undetected, undiagnosed. Maybe somebody thinks they have some symptoms. You have been the guy, the independent neurologist on the sideline of an NFL football game, and the point of that is to try to spot things that the coaching staff or the player, let's be generous and say they're preoccupied and not able to spot. Yes. And that's the reason there's at least three of us there that are at NFL Games, for example. In addition to the coaching staff, everyone in the stadium and they're watching live on TV in a lot of cases, looking for signs and symptoms. Some of them can be subtle, the way that someone is walking. Remember, they're premier athletes, so sometimes they can not quite fake it, but get through something and, as they say, shake it off. That's not right. If someone is observed to be injured and clearly meets the signs and symptoms they need to be taken out of the game, evaluated, and if they're positive for concussion, then back into the return to play algorithm that the NFL has established. The goal is to have this working at the junior levels for the younger athletes as well, especially based on this latest study. Wow. Let's grab another call. This is Jenny in Baltimore County. Jenny, thank you for calling. Go ahead. Jenny, are you there? Can you hear me? Yeah, you're on. What's your question? My question is, knowing what the doctor knows about the studies and everything that he's seen and heard, if he himself had a son or a grandson, would he let him play football? Thanks for the call. That's a great question. My wife's not here. We have perhaps different answers to this. Jeff and I were talking. My dad was a big football player. I played contact sports up through and in high school, all the way through it. There are many, many benefits to team sports, including contact sports, to teach not only teamwork, working with others, a goal-directed objective. There are many good, positive things. And keep in mind, even within this super selective study where they took brains that they knew perhaps there was something going on already, only 40%, 41% had evidence of this. 60% did not. So clearly, just the repetitive injury is not the whole story. There's something else, whether it's genetic or other. There's something we haven't quite found yet. Why is it the linemen in football that have such a high level of concern? You think about that. I mean, the highlight that makes SportsCenter is two people running at full speed, smashing into each other. The linemen aren't ever at full speed. Yeah. No, that's a great question. They've actually looked at that. And it's the head slapping that goes on between NFL linemen for a lot of it, right? These are 300-pound folks, very strong individuals. And there is a lot of handwork and armwork where their heads are getting batted around continuously on almost every play. A running back, which is also a great risk, for example, only has select plays that they're running and doing. But the linemen are generally there, play in, play out. So this is a cumulative concern. Is there a sport that maybe people wouldn't think it's a concern? But you know, based on what we've talked about, that parents, coaches, school authorities ought to give us some more thought. Yeah. We mentioned a couple of the big ones, football, hockey, soccer, but softball is a big one. And actually being hit by the ball counts for about 25% of the brain injuries that happened. We were in a helmet. Right? So they're hit by a ball that's being hit into the field of play. If you were in a camp. Right. Exactly. Now in baseball, a different story. Turn that around, it's being hit by a pitch that does that. And basketball, a sport that I wouldn't necessarily think, also has a fair percentage of CTE in concussions, which you wouldn't think of necessarily contact sport. But then again, we'd have to probably talk to some of our NBA friends. They'd probably disagree about that. I have time for one sentence on this. If there's an athlete watching who may have a concussion sometime, why is it important for them to report it? For your own health and safety. It's one thing to suck it up for a single game or another game. Folks have shown that even for championships, it's less reported. But please tell someone. Tell your coach. Tell your family. Dr. Gary Schwartzbauer of Shock Trauma, sir. We appreciate your time. Thanks for having me, Jeff. Appreciate it. Our health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.