Movie shines light on dangers of concussion

The movie “Concussion” is coming out Christmas Day. It is about Bennet Omalu, a pathologist who first described the signs of brain damage in football players, a condition known as chronic traumatic encephalopathy.

CTE is caused by repeated concussion. It’s especially linked to repeated concussion where the brain has not fully recovered from a first trauma before a second trauma is experienced. It’s been recognized since the 1920s in boxers who have had multiple concussions.

Signs and symptoms include neurologic problems like depression, impulsive behaviors, aggressiveness, irritability, memory problems, confusion and at times suicidal behavior. Symptoms frequently do not become apparent until someone is in his 40s or 50s.

Eventual progression to dementia is common. Diagnosis with additional neurodegenerative diseases such as motor neuron disease, Lewy body disease, amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), Alzheimer’s disease and frontotemporal lobar degeneration is not uncommon.

I have a friend and colleague who played football through college and suffered minor concussion many times. In his early 40s, he began to have weakness and discoordination and was diagnosed with ALS. He is still brilliant and wonderful, but can only move his eyes, and is dependent on a ventilator and 24-hour caretakers to stay alive.

So what is a concussion? Your brain weighs about 3 pounds and contains about 100 billion nerve cells, each one of which has somewhere around 7,000 connections to other nerve cells. Your brain does not have a lot of internal structure, and your skull encases it to protect it. A blow to the head breaks neural connections.

Every concussion should be taken seriously. They can have few or no symptoms, or there can be days to weeks of slowed thinking, irritability and problems with concentration and short-term memory. Even mild, repeated concussions can cause loss of thinking ability and IQ scores. Over time symptoms typically resolve, especially if the injured person rests and is protected from further blows to the head.

In young people, particularly those of high school age, a second concussion before full recovery from the initial one can cause sudden swelling of the brain that is potentially fatal. It is another reason why physicians, trainers and coaches take concussions much more seriously than they used to.

With effects from concussions more and more in the spotlight, the NFL and other governing organizations for contact sports are taking the accumulating evidence about effects of repeated concussion seriously and have introduced new rules about tackling, and new protocols for responding to concussions on the field. CTE is something we need to be aware of for other segments of the population such as military service members.

The NFL is also looking at changes in helmet technology to better protect players and to provide information indicating the severity of each impact the helmet receives. Although it is not yet known what level of concussion triggers CTE, the hope is that ongoing research will help figure this out. If this happens, the coaching and medical staff will be able to use information like impact severity to help assess a player’s fitness to return to the field.

The bottom line is that because we know there are long- and short-term consequences to concussion, athletes are no longer encouraged to shake off a blow to the head and return to play. I encourage my patients to wear appropriate helmets for all sports. I take this so seriously that if a kid refuses to wear a helmet, I advise the parent to take away the bike, skateboard, etc. Play hard, stay safe and take concussions seriously.

Dr. Bob Riggs is a family medicine physician practicing at Group Health’s Riverfront Medical Center.