served.
CTE was first discovered and results published by Dr. Bennet Omalu, a forensic pathologist originally at Allegheny County Coroner’s office in Pittsburgh. His story was highlighted in the 2015 Will Smith movie, “Concussion.” Dr. Omalu studied the brain of NFL player Mike Webster. Webster was considered one of the best centers in NFL history, winning four Super Bowls with the Pittsburgh Steelers. Webster’s post-NFL life was extremely difficult, with periods of homelessness and living in his truck. He died at the age of 50 years old from a heart attack. The Journal of the American Medical Association (JAMA) recently published the largest study to date of deceased football players (2017:318(4):360-370). In a sample of 202 brains do- nated by players at all levels of play of American football, 177 brains (87%) showed neuropathological findings consistent with CTE, including 110/111 (99%) of NFL players. The prevalence of CTE was correlated with level of play, with a significantly fewer pre-high school and high-school players demonstrating CTE (3/16 individuals) and a much higher frequency with college players (48/53). Severity of the pathological findings was also greater in the college and professional group. Despite these re- markable findings, selection bias is present, in that sampled brains were not randomly or prospectively evaluated, but instead do- nated from individuals who may have experienced cognitive or behavioral symptoms during life; thus, true prevalence of the condition cannot be accurately estimated from this study. In addition to the pathological findings, the study authors
performed telephone interviews with surviving family members. Of those individuals with brain pathology demonstrating mild CTE (27/202), 96 percent had behavioral or mood symptoms, 85% had cognitive abnormalities, and 33 % had signs of demen- tia. Of those with severe CTE (84/202), 89% had behavioral or mood symptoms, 95% had cognitive abnormalities, and 85% had signs of dementia. Thus, even milder CTE findings were as- sociated with significant behavioral, mood, or cognitive abnor- malities. The understanding of CTE is in its infancy. Scientists are just starting to create detailed neuropathologic criteria for diagnosis. The desire to identify biomarkers of the condition has led to blood testing, imaging studies, and cerebrospinal fluid evaluation. There is currently promise in the use of advanced imaging, especially MRI findings with attention to the brain volume in particularly sensitive areas.
Hopefully we will soon be able to identify more risk factors for CTE and be able to reduce the occurrence of this disorder.
Marshall C. Freeman, MD, FAHS, FAAN is the director of Head- ache Wellness Center (HWC) in Greensboro, NC. He is a board- certified neurologist in Adult Neurology, Neuromuscular Medi- cine, and Electrodiagnostic Medicine. He is a Fellow of the American Headache Society and holds specialty certification in Headache Medicine by the United Council of Neurological Subspecialties. HWC is the oldest and longest continuously op- erating headache specialty practice in North Carolina, serving the headache population since 1990. HWC is actively accepting new adult and pediatric patients. Please contact our office if you are interested in our current migraine studies. Visit www.Head-
acheWellnessCenter.com or call 336-574-8000. See ad on page 15.
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