New data indicates the ever present danger of chronic traumatic encephalopathy (CTE) in contact sports such as boxing, mixed martial arts (MMA), football, ice-hockey and even soccer. Contrary to popular belief it is now felt that it is just not concussive injuries but even sub-concussive injuries which can predispose an athlete to CTE. This may be of importance to a soccer player who repeatedly heads the ball during play. There are other questions for which we still do not have a good answer.
1. How many concussions are needed and how severe they need to be for CTE to develop? Is there a limit beyond which the brain loses its capacity to compensate for chronic trauma and signs and symptoms of CTE appear? If so what is this limit? Can it be defined? If a player stops playing before this limit is reached would CTE be aborted?
2. Once CTE develops can it be reversed?
3. Is there a way to protect the brain from developing CTE apart from changing the way the games are played. Changing the rules of the game (such as avoiding head butts during football, heading the ball in soccer, direct blows to the head in MMA, wearing safety gear/helmets) shall certainly help but are there other neuroprotective strategies such as medicines (antioxidants, anti-inflammatory drugs) which can be given to prevent the onset and progression of CTE?
As you can see there are many questions for which we still lack good answers. Making the games we play safer certainly sounds a logical principle and hence the thrust to identify concussions in a timely fashion on the playing field and rest the player till complete recovery is documented. Neurologists, neurosurgeons and other physicians skilled in neurosciences by virtue of their training are better equipped to identify concussions and thus there is a growing call to have them by the side of the playing field in every professional and now even college level game. Biomakers and imaging markers to identify CTE in the living brain are also been explored.
Till more is known about CTE and more importantly on how to prevent and reverse it, making the games we love and play safer should be the goal.
Nitin K Sethi, MD
Braindisease's Weblog 
Dear Doctor,
Here I am posting question about my father who is 50 year old. Around 3 years ago he experienced seizure with deep scream while he was sleeping lasting for 5 minutes. He experienced same thing after a month. After this he went to nuero physician…..and had done EEG, CT Scan…..both were normal. Physician prescribed him phenytoin(500 mg)….and advised to take one everyday for 3 years. But after taking phenytoin for 2 and half year ….my fahter started taking phenytoin every other day….and after couple of months he stopped taking medicine…just because he never had seizure after starting medication.However, after few months he experienced strong seizure he had never experienced before lasting more than 5 minutes. He went to same physician for advise and physician asked him to take phenytoin for 3 months right now and then ask for follow up.
He again started medicine…..but since last strong seizure attack he is feeling too tired, disoriented, anxiety, and shakiness. So, he went to local physican…. blood sugar report
showed that sugar level was just 78.Now, I am wondering if my father might have experienced Grand-mal Seizure because of hypoglycemia….if this is the case does he need do continue with anti epileptic? Beucase he has been taking phenytoin for almost 3 years and i am worried about its long term side effects. Please advise me…………thanks
Dear Dr. Sethi,
You broached this topic 2 years ago, and I a, wondering if there are any reliable updates as to LATENT Closed Head Injury Syndrome, which seems to be the ‘new term’? I suffered a skiing accident in 2006 where in i; without a helmet, fell at a moderate speed face first into a bolder and suffered a moderate (2-3 minute LOC) splitting open the bridge of my nose. for 2 weeks after I had the headache from hades. (They carried me off the mountain to a medical facility and performed a CT which was ‘negative’. When I fell and hit my head I felt my brain slam forward into the front of my skull then slam backwards and ‘giggle like jello’. Now, 2014, I am having memory loss, confusion, speech and movement issues. I have also been diagnosed with Narcolepsy with Cataplexy, RLS, PLMD, and Rem Sleep Behavior Disorder. The MRI conclusion reads:
CONCLUSION:
1. White matter of the brain shows scattered areas of high signal in the right hemisphere peripherally located which are indeterminate likely representing residua of migraine headache or trauma. Small vessel vascular disease could give this appearance.
There is note that Alzheimers and Lewy Body have been ruled out in the body of the MRI consult note.
Could the diagnosis preceding the Conclusion constitute the symptoms of Latent Closed Head Injury Syndrome? Additionally, I have begun a strange left handed tremor where my hand curls inward like a loose fist and my thumb shakes unless I ‘tuck it into my fist’.
I am seeing a Neurologist but can not get in to him until May. Since my diagnosis with all the sleep disorders I have worsened. I am wondering, if Spect Imaging would be helpful in diagnosing microvascular disease in the brain…
Thoughts?