Major breakthrough in concussion crisis

Researchers find signs of degenerative brain disease in an 18-year-old high school football player

By Bob Hohler
Globe Staff / January 27, 2009
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In an alarming discovery for the nation's youth football community, clinical researchers reported today that the brain of a recently deceased 18-year-old high school football player showed the earliest signs of an incurable debilitating disease caused by the kind of repetitive head trauma he experienced on the field.

The discovery represents a major scientific breakthrough in the sports concussion crisis, which threatens athletes from Pop Warner to the NFL as well as other contact sports, according to researchers at the Boston University School of Medicine's Center for the Study of Traumatic Encephalopathy. No scientist had previously documented the degenerative brain disease in a football player younger than 36.

"The findings are very shocking because we never thought anybody that young could already be started down the path to this disease," said Dr. Robert Cantu, a clincial professor of neurosurgery at BU Medical Center and a co-director of the brain study institute. "It should send a powerful message to people at every level of football that they need to care about this issue and treat concussions with respect."

Postmortem exams of the brains of six former NFL players who died prematurely between the ages of 36 and 50 have confirmed they suffered from the disease, chronic traumatic encephalopathy (CTE), the BU team said in a news conference near the site of the Super Bowl in Tampa. The researchers said the disease is caused by multiple head injuries and afflicts individuals similarly to early-onset Alzheimer's.

Only one of the seven brains of deceased NFL players that neurologists have reported analyzing since they began testing for CTE in recent years has not shown conclusive evidence of damage caused by the disease, the study team said.

The BU researchers also released their findings on the sixth player to be diagnosed with CTE, Tom McHale, who played nine seasons with Tampa Bay, Philadelphia, and Miami, and died last year of an accidental drug overdose at 45. The abnormalities in McHale's brain were distinctly similar to those found in the damaged brains of the other NFL football players, said Dr. Ann McKee, a neurologist who is director of BU's brain bank and co-director of the study center.

McKee said she has conducted postmortem exams of thousands of brains.

"I have never seen this disease in the general population, only in these athletes," she said. "It's a crisis, and anyone who doesn't recognize the severity of the problem is in tremendous denial."

Researchers also announced that a rapidly increasing number of former NFL players, including Hall of Famers Joe DeLamielleure and Willie Wood, have agreed to fight the disease by donating their brains after their deaths to the Sports Legacy Institute, which was founded last year and collaborates with the study center. Retired Patriot Ted Johnson was the first former NFL player to volunteer his brain to the center after his death.

The 18-year-old high school student, whose identity was withheld at his family's request, had suffered numerous concussions playing football and other contact sports, his parents told researchers. Though his brain showed only the earliest stages of the disease, the findings were "absolutely alarming," McKee said, because they confirmed that the disease can permanently damage an athlete's brain at a significantly earlier age than researchers imagined.

The 18-year-old had been playing contact sports within weeks of his accidental death, the researchers said. They declined to discuss how he died, other than to say it did not involve head trauma or violence.

"This should be a wakeup call, especially to parents, coaches and league administrators," said Chris Nowinski, a former Harvard football player and professional wrestler who is co-director of the BU center and author of the book, "Head Games: Football's Concussion Crisis." "We're exposing more than 1 million kids to early-onset brain damage and we don't know yet how to prevent it."

Had the teenager lived, neurologists said, he eventually would have developed early-onset dementia that would have advanced unabated until his death.

In McHale's case, researchers informed his wife, Lisa, that their postmortem exam showed extensive damage to his brain from CTE. They said the disease likely aggravated his attempt to overcome his addiction to painkillers. McHale also left three sons, ages 14, 11, and 9.

"We lost an absolutely amazing person," Lisa McHale said. "That's not going to change for us, but it would be a blessing if Tom's case helps to raise awareness about the disease and advances the research into it. That would go long way in giving some meaning to his death."

McHale was a successful restaurateur in Tampa when his life began to spiral out of control in 2005. His wife said he fought with "everything he had in him" to overcome his opiate addiction, including twice entering inpatient rehab facilities and undergoing outpatient treatment until his death. But even when he was in recovery from the addiction, which at times turned him into a "monster," she said, his behavior was unlike any she had previously witnessed.

A confirmed feature of CTE is that many years generally pass after a football player leaves the sport before the disease begins affecting his personality and behavior.

"The man who died in 2008 was very, very different from the guy I married," Lisa McHale said. "It was like he was a shell of his former self."

BU researchers said McHale's addiction played no role in his developing the brain trauma disease. Rather, they said, the CTE may have contributed to his addiction by affecting areas of his brain that control certain behavioral impulses.

"We have not yet been able to connect the dots between the brain damage related to CTE and a greater susceptibility to addiction, but we believe that's the case," Cantu said.

Regardless of a possible connection, McHale's CTE would have progressively damaged his brain and his ability to function normally, the neurologists said.

"That means I was never going to get Tom back, and the poor guy was never going to be his former self despite how hard he was trying," Lisa McHale said.

Scientists have explored the link between head trauma and brain disease since the 1920s. The disease, first associated with boxing, was initially known as dementia pugilistica and was believed to afflict about 1 in 5 professional boxers.

McKee said the youngest person in the world previously diagnosed with CTE was a 23-year-old boxer in England. Before McKee discovered the disease in the deceased 18-year-old, she said, the youngest individual in the United States whose CTE was confirmed by a postmortem exam was a 28-year-old autistic woman with a history of banging her head. (McKee's findings in the case of the 18-year-old were confirmed in an independent postmortem exam by Dr. E. Tessa Hedley-Whyte, a prominent neuropathologist at Massachusetts General Hospital.) Resarchers said they cannot estimate CTE's prevalence among football players, though some athletes appear to be more susceptible to the disease than others, indicating there may be a genetic link. Because the research remains in its early stages, scientists also have yet to determine how many blows to the head or how severe the hits must be to cause CTE. McHale, for instance, was not known to have suffered a concussion playing football, though he absorbed thousands of blows to his helmet.

Scientists also are exploring whether players are more susceptible to developing CTE at a particular age. They expect to discover the answers only through extensive research on the brains of deceased players.

To that end, retired NFL players have responded to the crisis by enlisting their colleagues to donate their brains to the BU study. With Nowinski serving as the chief recruiter, the initial list of 12 prospective donors has recently swelled, with researchers today announcing a new group of donors, including DeLamielleure, Dan Pastorini, Ken Gray, Harry Jacobs, Mel Owens, and Chad Levitt.

"It's unfair to the players, their wives, and their children that they have to pay such a price for playing a game they love," said DeLamielleure, 57, who played in the NFL with Buffalo and Cleveland from 1973 to 1985 and was renowned as O.J. Simpson's key blocker with the Bills.

"It's wrong. This needs to be fixed, and I'm going to do everything I can to bring awareness to it."

DeLamielleure, like many retired NFL players, said he had no idea how many concussions he may have endured on the field. He said he remembers blacking out on the sidelines numerous times after blows to his head.

"I remember the trainers bringing me back with smelling salts and telling me I got dinged," he said. "Then they would tell me I was OK and send me back out. Nobody knew the extent of our injuries."

Unlike DeLameilleure, who has not experienced any symptoms of CTE, former NFL player Brent Boyd said he suffers from post-concussion disability. Boyd, 51, played six seasons as an offensive lineman for the Minnesota Vikings in the 1980s.

"I know the indignities caused every day by mild traumatic brain damage," he said.

Boyd recently sent a letter to 2,000 retired NFL players imploring them to donate their brains to the study after their deaths.

"As NFL retirees, we already have given all we can of our bodies and brains, while alive at least," he wrote. "Here is one [more] chance to give something to the sport of football, not to the league owners or union, but to Pop Warner, high school, college, and future NFL players."

Researchers also announced that four members of "The 88 Plan," an NFL program that provides up to $88,000 a year in nursing care for former players with dementia, have agreed to donate their brains to the study center after their deaths. They are Wood, Willie Daniel, Wayne Hawkins, and Ralph Wenzel.

The study recently received a $250,000 grant from the National Operating Committee on Standards for Athletic Equipment, which aims in part to improve helmet safety.

The NFL, which has yet to acknowledge a direct link between football-related head trauma and CTE, is conducting a study on concussions and expects to release the results in 2010.

The BU researchers, however, believe the NFL study lacks the proper independence.

"It's hard for the NFL to do its own research because they have an implicit conflict of interest," said Dr. Robert Stern, a neurologist and co-director of the BU brain study center. "That's not to say I don't trust them, but it's like trusting the tobacco industry to do its own research on the link between cigarettes and lung cancer."

A common link between McHale and the other former NFL players who were diagnosed with CTE was the disturbing way they died. The five others were Houston linebacker John Grimsley, 45, who accidentally shot himself to death last year; Philadelphia defensive back Andre Waters, 44, who died of a self-inflicted gunshot in 2006; and three Pittsburgh players: Mike Webster, 50, Terry Long, 45, and Jason Strzelczyk, 36.

Webster was dogged by depression, drug abuse, and homelessness before he died of a heart attack in 2002. Long committed suicide by drinking antifreeze in 2006. And Strzelczyk died when the car he was driving at a high rate of speed collided head-on with a truck as police pursued him after he left the scene of a previous accident.

Lisa McHale said the brain center's findings convinced her that CTE contributed to her husband's demise, though she has accepted his official cause of death as an accidental drug overdose.

"I'm not interested in changing anybody's mind about how Tom died," she said. "But I'm speaking out because we know so little about CTE and the damage it can do."

She said she already knows enough, though, that she is reluctant to allow her two youngest sons to continue playing Pop Warner football.

"I'm very uncomfortable with it," she said. "I'm kind of hoping they decide on their own that it's not their sport."

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