Chapters Transcript CTE Continuum vs. CTE-Neuropathologic Change Course: 11th Annual NYU Concussion Conference: From Foundational Elements to Advanced Practice Well, thanks so much, uh, Doctor Iverson and uh Arsenega. This was uh really incredible to understand the research going on and, um, Grant in, in particular, uh, you, you've done exceptional work and just looking at the history of dementia pugilistica CTE and then CTE neuropathologic change, and I think you brought tremendous clarity to this. I was asked just to give um a a perspective from my point of view on, on, on all of this and And so this is where I do get into uh some disclosures. So I am the chief medical officer of the NCAA and I'm also a member of the advisory board of the diagnosed CTE that uh uh Doctor Asanga spoke about. In fact, I was asked very early on to be a member of, of the advisory board. That's a very interesting study, and I think it has. Probably the best acronym that I know of in science because diagnosed CTE stands for diagnostic Imaging and Genetic Network for the objective Study and evaluation of CTE. It's been going on for many years and, and, uh, we're still waiting for confirmation that we may have some objective biomarkers in life, but, uh, as we know right now, we don't. With regard to CTE and how this has affected sport, um, it, it's important to know that, uh, when it was first described as a new diagnosis by Dr. Omalu at the turn of the 21st century, that there was considerable fear and even paranoia that was going around the country and even uh much of the world about playing football or uh having a concussion, because originally, And Dr. Romano's research, it was stated that concussion could cause CTE. And again, this was the sort of generic CTE that is not specific as Doctor Iverson uh talked about. And even the original work from Boston University, the hypothesis was that concussion or repetitive concussion. Was the cause of CTE, the CTE that we were seeing neuropathologically. And then that hypothesis was revised to say that, well, it's repetitive head impact exposure that leads to the neuropathology of CTE. And then a lot of things became conflated as Doctor Iverson really uh so brilliantly pointed out. That CTE was being diagnosed in living people, and that individuals who presented with confusion, behavioral changes, and they had had concussion or repetitive head impact exposure, they were being told that they had CTE when indeed they may have had a treatable conditions. And then this moved into the court of law and uh another full disclosure, there are over 300 lawsuits against the NCAA that have to do with concussion or head impact exposure, saying that we, meaning the NCAA should have known. In the 1970s, and in the 1980s, and even in the 1990s, that having a concussion or playing football was going to lead to CTE. So this was sort of the fear and paranoia that has been going around and it's moved into the legal space as well. So one very interesting thing happened. I was approached by Doctor Robert Stern, who's one of the, our core principal investigators of the diagnosed CTE study and co-director of Boston University CTE Center. He approached me to write a book with him. And the book was written, published in 2019. It's part of the academic book Handbook of Clinical Neurology, and this particular volume is called Sports Neurology. And we were considered the two most unlikely of collaborators, uh, Doctor Stern sort of being the advocate for really looking at possible causes of CTE and Brian Heenline being in the NCAA and some people are saying, well, the NCA wanted to just shield everyone from the real science out there. So, uh, that certainly wasn't true, and what Dr. Stern and I really realized is that we both love sport. We both believe that sport is a public good. And we both believe that we need to understand the risk factors of playing sport, not just from the point of view of a possible neurodegenerative disease, but looking at all aspects of sport. And in 2019, in our textbook, I think it's important to note that we came up with the following questions or statements with regard to CTE. The first was, we do not know the specific risk factors for CTE, so this was written by Dr. Stern and myself in 2019. 2nd point, we do not know if some individuals are more or less vulnerable to CTE based on genetics. The 3rd point, we do not know the incidence and prevalence of CTE in sport and in the general population. The fourth point, we do not know the relationships of CTE to other neurodegenerative conditions and diseases. The 5th point, we do not know if all cases of CTE are progressive. And finally, we do not know if all of the clinical features reported to be associated with CTE are due to the uh uh uh uh the PA pathology. So this really is much of what Doctor Iverson uh has, has just told us. And so where do we go from here? Well, I can tell you where the Department of Defense and the NCAA and most sport governing bodies have gone. They do realize that repeated brain injury, it's not good for the brain, and indeed, it may be a risk factor for neurodegenerative changes. Importantly, the National Institute of Neurological Diseases and Stroke has said that repeated brain injuries is a risk for certain uh brain conditions. So what has happened in sport and in the military is that there has been a progressive momentum and unification of trying to reduce unnecessary repetitive head impact exposure. We've seen this across the globe in high-risk contact collision sports. And what we have noted is that this certainly has led to less injuries overall. And we believe that indeed it has made sport safer, and what has not happened is that by decreasing the amount of repetitive head impact exposure during, for example, practices in American football, rugby, and other sports, it has not led to a sudden increase in concussions or other severe injuries during competition. In other words, you can still prepare someone for a contact collision sport. Without having repetitive head impact exposure in practice. So that's very important. I think the other thing that has happened is that there's been a calming effect in terms of understanding that sport is important. And that where we are with CTE, it still is in its infancy, but importantly, we do not want to have any sort of gratuitous brain injury, and that's good for everyone, uh, overall. So this is just a, a little bit of a, a broad overview. But I think importantly, we need to all take a step back, understand we still are in our infancy to support fully studies such as diagnosed CTE and to support fully trying to understand whether the hypothetical framework, and that's hypothetical framework of chronic, traumatic encephalopathy syndrome, correlates with pathology that we are seeing postmortem. Published February 8, 2024 Created by Related Presenters Brian Hainline, MD View full profile
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