When Does Boxing-Related Head Trauma Become Too Much?

WEDNESDAY, April 18 (HealthDay News) — Professional fighters may
hit a threshold — a specific number of fights and years in the ring —
where they can no longer take blows to the head without brain damage, a
new study suggests.

But, once they cross that threshold, years might pass before symptoms
show.

“The brain can tolerate or absorb a certain amount of trauma and repair
itself,” explained study author Dr. Charles Bernick. The findings raise
the question of whether — and when — fighters should be medically
screened, so changes could be caught earlier and available treatment
offered, he said.

It’s already well documented that “the more exposure you have to head
trauma, the higher your risk of developing long-term complications.
Primarily, this condition is chronic traumatic encephalopathy,” said
Bernick, associate director of the Lou Ruvo Center for Brain Health at the
Cleveland Clinic in Ohio.

Also known as Boxer’s Syndrome, chronic traumatic encephalopathy is a
degenerative brain disease that causes the same kinds of thinking
difficulties and personality changes seen with Alzheimer’s disease.

As part of an ongoing study on brain health, the researchers divided
109 licensed boxers and mixed martial artists into three groups: those who
had fought for less than six years, six to 12 years or more than 12 years.
Their average age was about 29.

Participants underwent MRI scans to measure their brain volume and
tests of their thinking and memory.

“In those that fought less than six years, we didn’t find any changes,”
Bernick said. For that group, he said, “the more you fought didn’t seem to
make any differences in the size of brain structure or their performance
on some of the tests like reaction time.”

But for the other two groups of boxers and combat athletes, “the
greater number of fights, the sizes of certain volumes of the brain were
decreasing,” he said. “But, it was only in those that fought more than 12
years that we could detect the changes in performance in reaction time and
processing speed.”

Women made up about 10 percent of the fighters in the study, too small
a number to make any comparisons for now, Bernick said.

The study, released April 18, will be presented at the American Academy
of Neurology’s annual meeting in New Orleans, held from April 21 to
28.

“This is a cross-sectional study — just one point in time in all these
fighters’ lives,” Bernick said. “It needs to be substantiated and
confirmed, but it’s biologically plausible and it makes sense, and we’re
going to be following up on that.”

With repetitive head trauma, Dr. Howard Derman, medical director at the
Methodist Concussion Center in Houston, said “boxing is clearly more
dangerous than football, because the number of the hits to the head is
greater,” and no headgear is used at the professional level.

“The initial presentations may begin with things like deterioration in
attention, concentration, memory, disorientation, confusion and then they
get much bigger issues with dementia, and then it even progresses to
parkinsonian features,” Derman said. Parkinsonian features include
rigidity and tremor.

Derman isn’t convinced that a time lag always exists between early head
injuries from sports and measurable brain changes.

“Most of us believe that there is the period of quiescence, which is
why you’re seeing a lot of these [retired] football players in their 40s
and 50s developing an issue,” Derman said. “The disconcerting feature is
that there are multiple cases of athletes who are very young” showing
signs of chronic traumatic encephalopathy on autopsy, for instance after
dying in vehicle accidents, he added.

“Clearly, everyone who plays football or is a boxer does not develop a
dementia-like picture. It is fortunately a small minority of the athletes
that do,” said Derman, adding that genetic predisposition likely plays a
role.

Study author Bernick said that if further research confirms the
findings, “it may gave regulatory agencies, boxing athletic commissions,
guidelines on how to protect their athletes, when to perhaps require
evaluation.”

But that would be a hard sell, in Derman’s view.

“That probably won’t happen because the professional athletes — they
don’t want to know they have a problem, as funny as that seems. That’s
part of the issue,” Derman said.

“The big thing we can do is some kind of baseline testing on all
athletes, so we can compare where they are [after a head injury] with
where they were,” he said. “I think X-ray and MRI scans are a larger leap,
and players’ associations of all the leagues would really [be opposed].”

Data and conclusions presented at medical meetings should be viewed as
preliminary until published in a peer-reviewed journal.

More information

Learn about sports-related brain damage at Boston University’s Center for
the Study of Traumatic Encephalopathy
.

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