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Chris Nowinski, Ph.D. the Sports Concussion THE SPORTS CONCUSSION & CTE CRISIS: HOW NEW RESEARCH IS CHANGING HOW WE VIEW HEAD IMPACTS CHRIS NOWINSKI, PH.D. ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF MY HISTORY ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF CHRIS HARVARD IN IOWA ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF LIFE CHANGING IMPACT ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF DR. CANTU CHANGES MY LIFE Dr. Robert Cantu 4 in wrestling >2 in football ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF DR. CANTU’S 3 LESSONS 1. Dings are concussions 2. Immediate remove from play is essential, and no return until symptoms clear (and cleared by a doctor) 3. There may be long-term effects ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF NEW REVELATIONS? “During the past 7 years the practice has been too prevalent of allowing players to continue playing after a concussion. Again this year this is true. Sports demanding personal contact should be avoided after a concussion.” 1937 – Proceedings of the 17th annual American Football Coaches Association meeting ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF I DIG INTO CONCUSSIONS TO FIX MYSELF I should write a book! Advance: $4,000 Insurance: $21,000 ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF HEAD GAMES ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF ANDRE WATERS COMMITS SUICIDE • November 20, 2006 • “I think I lost count at 15.” He later added: “I just wouldn’t say anything. I’d sniff some smelling salts, then go back in there.” 12 ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF ConcussionFoundation ConcussionFoundation.org ConcussionFoundation ConcussionFoundation.org @ConcussionLF 13 @ChrisNowinski1 CONCUSSION LEGACY FOUNDATION ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF CONNOR MARTIN, OREGON Oregon high school football player sues for $38 million after suffering concussion. Suffered a concussion, cleared 4 days later, suffered another, symptoms may be permanent. ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF 15 RASHAUN COUNCIL AWARDED $7M Instead of calling 911, the coach called Rashaun’s mother, the lawsuit states. The boy’s father, Terry Council, arrived to find Rashaun on the ground, slumped over with his head between his legs, covered in his own vomit. His father took him to an emergency room, and Rashaun was diagnosed with a concussion and a subdural hematoma, a collection of blood between the brain and its outer covering. ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF 16 COMPLICATIONS – SHORT AND LONG TERM Weeks Months Years Second Impact Syndrome Delayed Return to Play Post Concussion Syndrome CTE? ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF SECOND IMPACT SYNDROME • Second Impact Syndrome occurs when an athlete, who has already sustained a head injury, sustains a second head injury before symptoms have cleared from the first injury • This second blow to the head, sometimes minor, can result in a loss of auto-regulation of the brain's blood supply, leading to rapid brain swelling. • 50% of SIS sufferers die, and the survivors rarely recover fully. It usually occurs to athletes <21 years old, although it can happen to older athletes Source: NY Times, Cantu, R. C. (1996). Head injuries in sport. British Journal of Sports Medicine, 30, 289-296. ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF CONCUSSION RATES BY SPORT Volleyball Baseball Softball Basketball (M) Fake News Basketball (W) Field Hockey Wrestling Soccer (M) Soccer (W) Lacrosse (M) Lacrosse (W) Ice Hockey (W) Ice Hockey (M) Football 0 2 4 6 8 10 12 College High School Source – Institute of Medicine ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF CONCUSSION EPIDEMIOLOGY • 730 Division I FCS football players • Questions: – How many concussions did you have last season? – How many additional concussions did you think you had but did not report? – How many dings or bell-ringers did you have? 1 6 21 Source: Baugh et al (2014) ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF DELAYED SYMPTOMS, DELAYED DIAGNOSIS • 3 Division FBS Football Programs Timing of Diagnosis Percent Immediately or within minutes 17% Later the same day 41% Next day 22% 2-4 days later 20% • Average diagnosis was 17 hours later ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF PATRICK CHUNG ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF CHUNG KO’D ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF LONG-TERM EFFECTS • One concussion = Parkinson’s 56% – Gardner RC et al. Mild TBI and risk of Parkinson disease: A Chronic Effects of Neurotrauma Consortium Study. Neurology 2018. • One concussion (no LOC) = Dementia 136% – Barnes DE et al. Association of Mild Traumatic Brain Injury With and Without Loss of Consciousness With Dementia in US Military Veterans. JAMA Neurology 2018. ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF CHRONIC TRAUMATIC ENCEPHALOPATHY ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF VA-BU-CLF BRAIN BANK • Founded in September 2008, the first center in the world dedicated to CTE research • Pathological, clinical, and basic science research • The world’s largest CTE brain bank now contains 630 brains and nearly 400 new cases of CTE ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF THE RESEARCH TEAM ConcussionFoundation ConcussionFoundation.org ConcussionFoundation ConcussionFoundation.org @ConcussionLF 27 @ChrisNowinski1 PUNCH-DRUNK • First named in 1928 by Dr. Harrison Martland ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF A NEGLECTED DISEASE? • Prior to 2005, there were only 45 cases of CTE in the medical literature! Primary Trauma Source 45 Boxing 39 Soccer 1 Battered spouse 1 Head banging behavior 2 Circus clown 1 Epilepsy 1 ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF 29 * Source: McKeet et al. 2009 © 2011 SLI Sign up at: ConcussionFoundation.org/Pledge ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF 2015 NINDS CTE CRITERIA • In CTE, the tau lesion considered pathognomonic is an abnormal perivascular accumulation of tau in neurons, astrocytes, and cell processes in an irregular pattern at the depths of the cortical sulci. Tau antibody staining of neurons and Lower field photo illustrating the neurites in perivascular pattern (arrow focal nature of the tau staining at pointing to blood vessel). depth of sulci (asterisk at bottom of sulcus). ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF Videos courtesy of Dr. Joel Stitzel, Wake Forest University - [email protected] ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF Walter J. Koroshetz, M.D. National Institutes of Health Director, National Institute of Neurological Disorders and Stroke “I don't think there's any wiggle room. It's pretty clear this is due to head injury. Whether there are other things involved, and when it starts, that's hard to know, but I don't think there's any question that it's related to head injury.” March 6, 2014. ESPN ConcussionFoundation ConcussionFoundation ConcussionFoundation.orgConcussionFoundation.org @ChrisNowinski1@ConcussionLF Daniel Perl, M.D. Professor Director of CTE Research Department of Defense Uniformed Services University “CTE is only seen in the setting of repeated head trauma. At the end of the day, this is produced by head trauma. I'm sorry, that's what all the research says.” March 6, 2014. ESPN ConcussionFoundation
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