Experts in concussion, NFL leaders gather to identify gaps in knowledge, offer guidelines on preventing brain injuries

With growing attention on traumatic brain injury and chronic traumatic encephalopathy, known as CTE, in sports, clinicians and researchers from across the country, including doctors from the NFL, are offering guidance on how to prevent further harm in athletes.

Experts in athletic brain injury and long-term cognitive disorders gathered at a summit Friday at the Cantu Concussion Center at Emerson Health in Concord, Massachusetts, “to gather and share their findings, with a goal of identifying gaps in current research that need to be addressed,” according to a consensus statement from the group.

“The intent was to bring clinicians and researchers that work in this space together,” said Dr. Robert Cantu, medical director at Emerson Health’s Cantu Concussion Center and a pioneer in recognizing and treating concussions and traumatic brain injuries in professional and youth athletes. “Not everybody agrees on everything, but to inform us where we are together and where we’re not together, identify gaps of knowledge that we will then try to propose research that will close those gaps.”

The consensus statement laid out several recommended guidelines, including eliminating unnecessary contact to the head and neck areas during practice and games, and penalizing players for such contact.

“Having a collision sport or a contact sport doesn’t mean that that collision or contact has to involve the head,” said Dr. Allen Sills, chief medical officer of the National Football League and one of the organizers of the conference. “You can play a sport in which there is contact between or among players, but we should try to get the head out of that contact whenever possible.”

These guidelines have already been implemented within the NFL, Sills noted. Other medical advisers to the league also participated in the event, which was supported by an unrestricted educational grant from the NFL.

The conference consisted of three session focusing on the pathophysiology of traumatic brain injury and CTE as well as concussion and repetitive traumatic brain injury prevention, and how to diagnose CTE in people who are living.

CTE has only been formally diagnosed with an autopsy in brain donors who were suspected of having the condition. Cantu noted a need to further identify how to define the criteria for CTE diagnosis.

“That was one of the areas where gaps in knowledge were most identified,” he said of the summit. “Many of the signs and symptoms of CTE or traumatic encephalopathy syndrome involved mood issues of depression, anxiety, panic attack that are prevalent not just in that syndrome but in many other conditions as well.”

The Alzheimer’s-like disease is most commonly associated with former professional football players but has also been detected in military veterans, including many who have been exposed to roadside bombs and other types of blasts.

CTE is pathologically marked by a buildup of tau protein in the brain that can disable neuropathways

Research has shown that repetitive hits to the head – even without a concussion – can result in CTE, which has been associated with memory loss, confusion, impulse control problems, aggression, depression, impaired judgment and suicidal behavior.

The summit participants also discussed the role of repetitive head impacts in the development of multiple diseases of the brain, spinal cord and nerves throughout the body.

Dr. Julie Stamm, a clinical assistant professor at the University of Wisconsin-Madison who was not involved in the summit, says it’s exciting to see a lineup of experts coming together to discuss not just CTE but other conditions related to traumatic brain injury.

“It’s not all about CTE,” she said. “Other diseases like Parkinson’s disease or Lewy body dementia have been linked to repetitive brain trauma. So including those in the conversation is also important because CTE clearly is a disease of concern, but these other diseases also need to be talked about.”

CTE is a major concern in the sports community, Stamm says, because the disease is now being diagnosed in younger athletes.

In a study of 152 athletes who died before the age of 30, published this year in the journal JAMA Neurology, researchers noted that 87 of the brain donors had died by suicide, including 33 who had CTE.

One of the donors was 18-year-old Wyatt Bramwell, who died by suicide in 2019. Bramwell is the first high school football player to be diagnosed with stage 2 CTE, according to researchers at the Boston University CTE Center.

This year, scientists in Australia also diagnosed the world’s first case of CTE in a professional female athlete, Heather Anderson, an Australian Football League player who was found to have low-stage CTE. She was 28 years old when she died by suicide last year.

Back in the states, CTE has been discovered in a number of NFL athletes. In a study earlier this year, Boston University’s CTE Center found that nearly 92% of 376 former NFL players whose brains were studied had CTE.

Sills says CTE is not an NFL issue but a public health issue.

“Everyone in this area can rally behind some of these basic principles around avoidance of head contact and how important it is to address that in practices and in games and work on the rules of play,” he said, adding that continued research is also needed to address differences of opinion on the matter.

“Science advances by having a theory and then testing that theory, and getting data that tests it, and then refining that theory and revising it and then retesting it, and that’s just the nature of scientific progress,” he said.

Cantu, the summit’s namesake, says the conference is just the beginning of a growing movement to address sport-related traumatic brain injuries.

“I think it’s quite a positive thing for the NFL, to have made this conference possible and bring all these individuals together. And I would hope other professional sports would follow that.”