0
Chronic Traumatic Encephalopathy
               in the NFL




www.sportslegacy.org
                                Christ...
One Athlete‟s Experience

 I was forced to retire from the WWE from concussions received in football and wrestling


2 und...
My Concussors


   5            6       4
    5




                    1       3
            2
An Education Comes Too Late

I didn’t have the right information to protect myself from concussions

      After my sympto...
First Cases of CTE in Former NFL Players

Mike Webster and Terry Long were the first 2 CTE cases in former NFL players
   ...
Depression and Memory Impairment in NFL Retirees

 Memory impairment and depression appear to be linked to brain trauma ex...
Incidence of Concussion in Football – Trainer Data

 According to medical professionals, concussion is rare in football


...
Incidence of Concussion in Football – Player Data

Players simply do not report concussions, so they don’t exist in medica...
Incidence of Concussion in Football
Data Source Comparison

•      Due to a lack of awareness of the symptoms and conseque...
Andre Waters and CTE

Andre Waters was the first post-mortem brain examination I became involved in


• Andre Waters was a...
Andre Waters Images and CTE Symptoms

      Andre Waters was diagnosed with CTE, and was exhibiting symptoms prior to deat...
Sports Legacy Institute

     “(This) groundbreaking research may be providing the most
       significant concussion disc...
Sports Legacy Institute Team
                Founding Members

               CHRISTOPHER NOWINSKI– President
            ...
Wrestler Kills Wife and Child, Then Self
June 23rd-25th, 2007




 •   Between June 23rd and
     June 25th, World Wrestli...
15
Center for the Study of Traumatic Encephalopathy

•        September 2008 SLI and BU founded the first ever research cente...
John Grimsley

•       1st NFL case studied at BU – 5th overall. Died Feb 2008 of self-inflicted gunshot wound
    • Houst...
John Grimsley Findings

•      John Grimsley had remarkable brain damage for a 45 year-old man



    • For the 5 years
  ...
Tom McHale

•       6th NFL Case of CTE. Died of a drug overdose

    • Defensive lineman at Cornell and Maryland
    • Of...
Tom McHale

•   6th NFL Case of CTE
                                            •Pathology – Neurofibrilary Tangles, astro...
Earliest Evidence of CTE – 18 Year-Old Boy




                                             21
22
The CSTE Brain Bank Registry

•        Living athletes are lining up to be part of this groundbreaking research

    •    ...
…and Inspired Real Change

                                                                      Study finds NHL
         ...
Age-Adjusted Death Rates from Lung Cancer by
     Smoking Level, CPS-I
     •      The first definitive data on smoking/lu...
Analog - Smoking and Lung Cancer

It took 50 years for meaningful change after discovering that smoking causes lung cancer...
Athletes Aren‟t Getting What they Need

                                   •   Yet there are virtually
  •    An urgent ne...
Contact Sports Participation – High School Boys



  1 in 8 boys
 plays tackle
   football




* Center for the Study of R...
Joining the CSTE Registry


    • Why should you join the registry?

  My personal thoughts:
    • We only need ~50 footba...
Joining the CSTE Registry


    • Why should you join the registry?

  More personal thoughts:
    • Registry members will...
Other Benefits of the Registry

•   Immediate:
     – Prevent CTE tragedies (suicides, murders) by creating awareness and ...
Thank You




  • See me for brochures and sign-up forms


                    Questions?
             nowinski@post.harva...
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Chris Nowinski Presentation on Brain Injuries at Independent Summit

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Chris Nowinski did a presentation on sports-related Brain Injuries at the Independent Retired Football Players Summit at the South Point Resort & Casino in Las Vegas May 2009

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Transcript of "Chris Nowinski Presentation on Brain Injuries at Independent Summit"

  1. 1. Chronic Traumatic Encephalopathy in the NFL www.sportslegacy.org Christopher Nowinski SLI Co-Founder & President Co-Director, CSTE at BUSM NFL Independent Summit May2009
  2. 2. One Athlete‟s Experience I was forced to retire from the WWE from concussions received in football and wrestling 2 undiagnosed 4 undiagnosed concussions, Retired in 2003 at age concussions leading to: 24 – Headaches – Symptoms persist – Memory impairment to this day – Depression – Sleep activity + =
  3. 3. My Concussors 5 6 4 5 1 3 2
  4. 4. An Education Comes Too Late I didn’t have the right information to protect myself from concussions After my symptoms persist and 8 doctors can‟t help me, I visit Dr. Robert Cantu I wrote Head Games to warn others because studies show athletes are not informed of the risks. If the damage is partially preventable, how can we not tell athletes how to protect themselves? Boston Globe Magazine Shockingly, he is the first to tell me that: Concussions are cumulative and can have long-term effects “Resting concussions” helps them heal
  5. 5. First Cases of CTE in Former NFL Players Mike Webster and Terry Long were the first 2 CTE cases in former NFL players Mike Webster Terry Long Died at 50 Suicide at age 45 • CTE was first identified in 1928. In 1990, it was estimated that 17% of boxers develop CTE (Roberts), although the precise incidence is likely much higher. • The medical examiner wrote it was characteristic of boxers “who take considerable head punishment seeking only to land a knockout blow” and also “common in second rate fighters used for training purposes.” • Prior to the NFL cases, only 46 CTE cases existed in the medical literature • It remains unclear whether concussions or the thousands of subconcussive blows each athlete received was more responsible for creating the brain damage found 5
  6. 6. Depression and Memory Impairment in NFL Retirees Memory impairment and depression appear to be linked to brain trauma exposure • A survey of 2,552 former NFL players with >3 years NFL experience found that those who remembered having more concussions had a significantly higher incidence of being diagnosed with depression. • Similar data exists for self-diagnosed memory impairment 25% 20.2% % Diagnosed with 20% Depression 15% 9.7% 10% 6.6% 5% 0% 0 1 to 2 3 or more * Center for the Study of Retired Athletes 6
  7. 7. Incidence of Concussion in Football – Trainer Data According to medical professionals, concussion is rare in football • When athletic trainers are surveyed on how many concussions they see each season, they consistently find that between 2% and 6% of football players suffer concussions each season.* Source Level Incidence Powell et al (1999) High School 3.6 % Guskiewicz et al (2000) HS/College 5.6 % Guskiewicz et al (2003) NCAA 6.3 % McCrea et al (2002) HS/College 3.8 % Zemper (2003) HS/College 4.1 % Gerberich et al (1983) High School 2.4 % 7
  8. 8. Incidence of Concussion in Football – Player Data Players simply do not report concussions, so they don’t exist in medical records • When players are surveyed directly, anonymously, after the season, and the word “concussion” is removed from the questions (instead, they ask about symptoms), players appear to be suffering 10 to 50 times more concussions than they tell athletic trainers (or coaches). Source Level Incidence Average Langburt et al (2001) High School 47.2 % 3 Delaney et al (2002) College 70.2 % 4 Delaney et al (2000) CFL 47.8 % Woronzoff (2001) College 61.2 % McCrea et al (2004) High School 15.3 % used “concussions” Moreau (2005) High School 65.2 % 8
  9. 9. Incidence of Concussion in Football Data Source Comparison • Due to a lack of awareness of the symptoms and consequences of concussions, youth athletes aren‟t reporting concussions to adults – Fewer than 10% of concussions are being reported to athletic trainers – Less than half of high schools can even afford part-time athletic trainers Data Source in published study: Trainer: Athlete: Percent of 3.6 % 47.2 % players reporting concussions: 5.6 % 70.2 % 6.3 % 47.8 % 3.8 % 19.0 % 4.1 % 61.2 % 2.4 % 15.3 % 5.6 % 65.2 %
  10. 10. Andre Waters and CTE Andre Waters was the first post-mortem brain examination I became involved in • Andre Waters was an NFL safety from 1984- 1995, mostly with the Philadelphia Eagles where he was an All-Pro. • Waters committed suicide on November 20, 2006. • Asked in 1994 by The Philadelphia Inquirer to count his career concussions, Mr. Waters replied, “I think I lost count at 15.” He later added: “I just wouldn‟t say anything. I‟d sniff some smelling salts, then go back in there.” 10
  11. 11. Andre Waters Images and CTE Symptoms Andre Waters was diagnosed with CTE, and was exhibiting symptoms prior to death • Symptoms - symptoms of CTE are insidious, first manifest by Healthy Brain Tissue deteriorations in attention, concentration, and memory, as well as disorientation and confusion, and occasionally accompanied by dizziness and headaches. With progressive deterioration, additional symptoms, such as lack of insight, poor judgment, and overt dementia, become manifest. Andre Waters Severe cases are accompanied by a progressive slowing of muscular movements, a staggered, propulsive gait, masked facies, impeded speech, tremors, vertigo, and deafness 11 * Cantu, R
  12. 12. Sports Legacy Institute “(This) groundbreaking research may be providing the most significant concussion discoveries and the most startling and potentially devastating findings (in sports medicine).” August 5, 2007 - Bob Ley, ESPN • Incorporated June 14th, 2007 • The Institute will initially focus its efforts on the study of degenerative brain conditions Research Treatment including Chronic Traumatic Encephalopathy, or CTE, a condition caused by repetitive concussive and sub-concussive brain injuries. Education & Prevention 12
  13. 13. Sports Legacy Institute Team Founding Members CHRISTOPHER NOWINSKI– President Consultant, Trinity Partners LLC, Waltham, MA Author, Head Games: Football‟s Concussion Crisis Former WWE professional wrestler ROBERT CANTU, MD Chief of Neurosurgery Service and Director of Sports Medicine, Emerson Hospital, Concord, MA Co-Director, Neurologic Sports Injury Center Brigham and Women‟s Hospital, Boston, MA Medical Advisory Board Athlete Advisory Board Board of Directors Robert Cantu, MD, (Chairman) Ted Johnson, NFL Christopher Nowinski Robert Stern, PhD, Assoc. Prof. of Pat LaFontaine, NHL Eleanor Perfetto, Senior Director, Neurology, BU Medical School Isaiah Kacyvenski, NFL Pfizer James Beck, MD, PhD, Prof. of Cindy Parlow, Soccer John Corcoran, Founder and Psychiatry, Harvard Medical Brent Boyd, NFL Managing Partner, Trinity School Partners Ben Lynch, NFL Ann McKee, MD, Assoc. Prof. of Isaiah Kacyvenski, NFL veteran Neurology and Pathology, BU Malcolm Huckaby, NBA Scott McCabe, Merrill Lynch Medical School Booker T, Pro wrestler David Hovda, PhD. Director of UCLA Rob Van Dam, Pro wrestler Brain Injury Research Center Noah Welch, NHL Honorary Trustees Vin Ferrara, Founder CEO, Xenith Inc. Matt Henshon, Esq. Henshon, Parker LLP Pro bono legal counsel Tina Cantu, RN, MBA, JD Neurosurgical provided by: Surgery, Inc. 13
  14. 14. Wrestler Kills Wife and Child, Then Self June 23rd-25th, 2007 • Between June 23rd and June 25th, World Wrestling Entertainment performer and 23-year pro wrestling veteran Chris Benoit killed his wife Nancy and 7 year- old son before hanging himself. (Photo courtesy of Michael Benoit) • The media and even the US Congress focused on the fact that Benoit had steroids in his system • Had told numerous people, including SLI president Chris Nowinski, that he‟d experienced „more concussions than he could count‟ and had exhibited depression, memory impairment, and erratic behavior, including paranoia, in the years preceding the events. 14
  15. 15. 15
  16. 16. Center for the Study of Traumatic Encephalopathy • September 2008 SLI and BU founded the first ever research center dedicated to CTE A Collaboration Between Sports Legacy Institute and Boston University School of Medicine Goals 1. Establishment of Brain Donation Registry • Current or retired athletes, with and without history of concussion, to agree to donate brain tissue following death. 2. Conduct Clinical Research • Examinations of retired athletes, including cognitive, mood, and neurological assessments, as well as brain MRI and spinal taps (to measure proteins in cerebrospinal fluid). Study longitudinally and examine brains following death. 3. Expansion of Brain Bank • Brain tissue repository for the examination of the underlying neuropathology associated with repetitive concussion in athletes. 16
  17. 17. John Grimsley • 1st NFL case studied at BU – 5th overall. Died Feb 2008 of self-inflicted gunshot wound • Houston Oilers 1984-1990 • Miami Dolphins 1991-1993 • Linebacker; Named to Pro-Bowl, 1988 • No history of performance-enhancing drugs • No significant medical history • Concussion history: • 3 concussions during college football at Kentucky • At least 8 concussions during NFL career • Only one quot;cerebral concussion“ medically confirmed • Died of gunshot wound to chest, apparently while cleaning gun. Police report: no evidence of suicide, believed to be a “very tragic accident.” 17
  18. 18. John Grimsley Findings • John Grimsley had remarkable brain damage for a 45 year-old man • For the 5 years prior to his death at age 45, he reportedly was experiencing worsening memory and cognitive functioning, as well as increasing “short fuse.” • Although increasing use of alcohol, no evidence of • 65 yr old • Grimsley at 45 • 73 year old boxer depression, sadness, healthy control years old with dementia hopelessness. No alcohol in blood at time of death.
  19. 19. Tom McHale • 6th NFL Case of CTE. Died of a drug overdose • Defensive lineman at Cornell and Maryland • Offensive lineman in college • Tampa Bay Buc 1987-1992 • Philadelphia Eagles 1993-1994 • Miami Dolphins 1995 • No recorded concussion history, although teammates have come forward with at least one story of Tom being unable to remember plays on the field 19
  20. 20. Tom McHale • 6th NFL Case of CTE •Pathology – Neurofibrilary Tangles, astrocytic tangles, and dot like and spindle-shaped NNs are • Tom opened and operated multiple common in the dorsolateral frontal, subcallosal, insular, successful restaurants after retiring temporal, dorsolateral parietal, and inferior occipital • Began experiencing problems with drugs, cortices. The tauimmunoreactive neurofibrillary beginning with painkillers from a back pathology is characteristically irregular in distribution problem. In and out of rehab in the last with multifocal patches of dense NFTs in the superficial years of his life cortical layers, often in a perivascular arrangement 20
  21. 21. Earliest Evidence of CTE – 18 Year-Old Boy 21
  22. 22. 22
  23. 23. The CSTE Brain Bank Registry • Living athletes are lining up to be part of this groundbreaking research • National Football League (34) • National Hockey League (5) • Ted Johnson • Keith Primeau • Joe DeLamielleure • Noah Welch • Isaiah Kacyvenski • Steve Heinze • Ben Lynch • Ryan Vandenbussche • Bernie Parrish • Pro Wrestling (15) • Ralph Wenzel • Rob Van Dam • Frank Wycheck • Lance Storm • Bruce Laird • Chris Nowinski • Brent Boyd • Spike Dudley Level Donors • Mel Owens • Molly Holly • Dan Pastorini • April Hunter Pro 73 • Billy Ray Smith • Al Snow Amateur 45 • Ken Gray • Boxing • Harry Jacobs (more) • Termite Watkins • National Basketball Association • Soccer • Paul Grant • Cindy Parlow • Malcolm Huckaby Swimming • Jenny Thompson • As of May 2009 23
  24. 24. …and Inspired Real Change Study finds NHL NHL warns teams of WWE wrestler players out 41% SLI stiffer penalties and Andre Waters Chris Benoit longer per concussion incorporated fines for head shots suicide - 3rd NFL 5th CTE case than 1 year ago CTE Case Living Donor Registry NFL issues concussion SLI and Boston University reaches 100 brains NFL wives Mackey, management guidelines School of Medicine partner to Perfetto speak out found Center for the Study of Traumatic Encephalopathy Jan. 2007 July 2007 Jan 2008 July 2008 Jan 2009 Ted Johnson speaks out on eve of Tom McHale Super Bowl WWE implements John Grimsley 6thNFL CTE case concussion program 5th NFL CTE case NFL holds SLI members profiled “Concussion on HBO Real Sports Summit” NHLPA seeks ban on hits to head Justin Strzelczyk 4th NFL case NFL tells referees to NFL announces 4 eject players for new rule changes helmet-to-helmet hits to protect heads 24
  25. 25. Age-Adjusted Death Rates from Lung Cancer by Smoking Level, CPS-I • The first definitive data on smoking/lung cancer Rate/100,000 person-years 250 200 200 Nonsmoker 155 150 1-9 cig./day 10-19 cig/day 100 89 20-39 cig/day 55 50 40+ cig/day 10 0 Source: Lilienfeld (p.207) Source: Patrick Remington, MD, MPH: Prevention and the Continuum of Disease Causation
  26. 26. Analog - Smoking and Lung Cancer It took 50 years for meaningful change after discovering that smoking causes lung cancer Smoking and Lung Cancer Timeline 1997: US tobacco firms agree a multi- 1950 – first 1953 - Big 1965 – 1984 - American billion-dollar small study Tobacco forms Surgeon Association for 1994: Seven settlement to cover finds smokers Tobacco Institute General Cancer Research Dwarves testify healthcare costs twice as likely Research warning accepts the before incurred by treating to die from Committee added to evidence Congress people with smoking- lung cancer (quot;TIRCquot;), packaging gathered by related illnesses cancer scientists 10 years 20 years 30 years 40 years 50 years 1994 – NFL founds 2007 – Andre 2008 – SLI/BU ? Committee on Mild Waters suicide Center for the Study Traumatic Brain linked to brain of Traumatic Injury damage from Encephalopathy – concussions Brain Bank 1992 – Al Toon of NY established Jets retires from post- 2007 – SLI founded concussion syndrome 2007 – Benoit tragedy Concussions and CTE Timeline 26
  27. 27. Athletes Aren‟t Getting What they Need • Yet there are virtually • An urgent need no programs in place exists for: focused on filling those needs Research Treatment Prevention Education
  28. 28. Contact Sports Participation – High School Boys 1 in 8 boys plays tackle football * Center for the Study of Retired Athletes 28
  29. 29. Joining the CSTE Registry • Why should you join the registry? My personal thoughts: • We only need ~50 football brains, so by joining you are far more likely to benefit from the results of the research than to participate • You don‟t do any work, but get all the benefits – All you need to do is answer a phone call once a year. CSTE does all the work after you are deceased. It will not be a burden to your family, and it will not affect an open casket. You won‟t feel a thing – For the rest of your life you get to feel great about giving back to the game and to your fellow players. It‟s great cocktail party conversation 29
  30. 30. Joining the CSTE Registry • Why should you join the registry? More personal thoughts: • Registry members will be involved in future studies on treatment (we‟ll know where to find you) • Publicity – the media loves covering this issue, so it will help raise awareness of the issue • It will help your former teammates, your children and grandchildren 30
  31. 31. Other Benefits of the Registry • Immediate: – Prevent CTE tragedies (suicides, murders) by creating awareness and encouraging ex-athletes to seek treatment – Drive potentially millions of „silent sufferers‟ to seek treatment – Educate - Prevent future cases in active players but changing the way the games are played • Long-term: – Develop better evaluation and treatment protocols for this unique – Develop new pharmaceutical interventions using the data generated by the brain bank - currently no cure or studies on concussion-caused brain damage and CTE – Improve our understanding of the relationship between repetitive concussions and long-term CTE – Determine relationship between repeated concussions and later psychiatric and cognitive impairments – Prevent suffering – Save lives 31
  32. 32. Thank You • See me for brochures and sign-up forms Questions? nowinski@post.harvard.edu www.sportslegacy.org www.chrisnowinski.com
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