Notes On The Concussion Crisis: CTEM And The New Lou Gehrig Connection

If you haven't read Jonah Lehrer's article on concussions, and the teenage brain over at Grantland, I suggest you do so. It's a fascinating scientific exploration of why brain trauma is so critical in teenagers: the teenage brain is itself experiencing a critical period. It's like throwing a banana peel underneath the foot of a runner in the 100 meter dash. In the context of neural development, your brain (particularly the frontal cortex, which is important for judgment and impulse control) is scrambling to get near the finish line while you're a teenager.

The statistics reveal this growing reality, as the Journal of Pediatrics show that 144 thousand individuals under the age of 18 are treated for concussions in the emergency room every year. It's actually kind of shocking to think MMA has yet to truly confront this problem, but then we have no amateur system to truly chronicle.

However, that's not to say the problem doesn't exist. Recently, Satoshi Ishii, an Olympic Judoka who was once the ‘talk of the town', suffered a brain injury in his Fedor bout, in this case cerebral edema, that will likely end his career (Ryo Chonan is denying the report, however, explaining that Ishii is fine).

When it comes to the ‘concussion crisis', there always seems to be a new angle to explore. We hear whispers about concussions being associated with depression, and perhaps addiction. We hear whispers about concussions and their associations with Parkinson's. The latest angle connects concussions with Lou Gehrig's disease (or amyotrophic lateral sclerosis). It's a connection that has given birth to an actual disorder: as a riff on CTE (chronic traumatic encephalopathy), this new worry has been dubbed chronic traumatic encephalomyelopathy (CTEM).

As Jeffrey Bartholet reports in the February issue of Scientific American, Ann McKee of Boston University, one of the foremost experts on CTE, notes how the brains of deceased athletes are beginning to show signs of more than just the abnormal deposits of the tau protein that characterize CTE.

"In about 13 percent of CTE cases studied, the deceased had also been diagnosed with ALS - a very high percentage", Bartholet explains. However, what makes this number unique is that abnormal deposits of a protein called TDP-43, which shows up in patients with ALS, are also showing up in patients with CTE, but the proteins exist in their own distinct pattern (and on different parts of the brain), suggesting we are dealing with a distinct disorder, and a disorder that indicates a direct cause, just as CTE does: repeated blows to the head.

However, if there's one thing Bartholet deserves credit for, it's in making sure the skeptics get a voice.

"There are many nuances to data even when they are clear cut", Armon (Carmel Armon, a Professor of Neurology at Tufts University) says. For instance, tau and TDP-43 could be causal agents of brain disease, or they could be part of a response mechanism in the brain to fight the disease. Even if they are causal, they could be contributing to two different diseases. "The data don't support that CTE and CTEM are part of one continuum," Armon asserts.

Questions are vital to the discourse on the so called ‘concussion crisis' precisely because CTE itself is not completely understood. Why do some players and not others experience dementia? Where do we draw the line between correlation and causation? If I disagree anywhere with Lehrer it's this idea that contact sports are ready to have their tombstones engraved when there are clearly a lot of unanswered questions. Hopefully MMA can begin to take part in this discussion before real tragedy strikes, as it has in other sports.