The latest CTE news

I read with dismay the latest news that chronic traumatic encephalopathy (CTE) has been identified in a young man who played mostly amateur soccer. Patrick Grange played soccer throughout his childhood and in college and even in semi-pro leagues. He developed amyotrophic lateral sclerosis (ALS) in his mid-20s and died at age 29. His brain was studied and the pathology reported is a grade 2 case (out of a 4-point scale) of CTE.

Here I want to make two points. First, this news further deepens parents’ and young people’s dilemmas regarding sports. The most commonly played organized sport among youth in the world, even in the latecomer U.S., is soccer (or football in the parlance of the world outside of the U.S.). Much was made of Patrick Grange’s penchant for head-butting the ball. However, it is not clear at all that Mr Grange’s CTE was a result of his head-butting proclivities. His parents report that he suffered from at least 3 serious concussions. Regardless of which injuries were in the straw-pile that broke the camel’s back, I think that most parents recognize that soccer can be a dangerous sport. Weighing the positive physical and social benefits of team sports against the potential for future disability is a personal judgment call. The influence of future harm upon the final decision is greatly impacted by discounting as discussed in a previous post.

The second point to be made here is the connection between ALS and CTE. ALS is often called Lou Gehrig’s disease because the great New York Yankee died of ALS just before his 38th birthday. The key symptoms associated with ALS are distinctive. Both motoneurons (the neurons that innervate skeletal muscles) and corticospinal neurons (the neurons that excite motoneurons to produce volitional movement) die in ALS. In other diseases such as polio or stroke, only the motoneurons or only the corticospinal neurons, respectively, are affected. So the combination of symptoms resulting from motoneuron and corticospinal neuronal death is what marks ALS. It appears that several athletes with CTE have also shown the clinical signs of ALS. The question is whether they have ALS or whether the CTE has produced ALS-symptoms through a different mechanism. This question was addressed in 2010. Personally I think that the small sample size of that study – 12 patients were studied, 3 of whom had ALS – is just too small to answer this question. You may wonder if Lou Gehrig might have had CTE and the answer is that that is a distinct possibility as he suffered at least one notable concussion. We will never know because he was cremated after his death.

What difference does it make whether an individual’s ALS-symptoms are caused by ALS or by a distinct mechanism associated with CTE? The answer is that diseases that look alike but result from different mechanisms have to be treated differently. For example, an ischemic stroke (produces its damage by blocking blood flow and thereby oxygen delivery) and a hemorrhagic stroke (produces its damage by bursting a vessel) in the same spot will present indistinguishable symptoms. However, the former should be treated by blood-thinners; not so much for the latter. Unfortunately, no treatment (beyond palliative care) exists for either ALS or CTE. So for now, this debate is interesting but not of practical consequence.


    • Haozhe highlights a thought-provoking opinion piece. I agree that it is worthwhile reading. I will respond with my own take on this but I will say at the outset that I consider this a highly personal issue and a sticky wicket with no easy answer. I am not sure what is right.
      For me, the up-side of watching football is basically that I enjoy it because it reminds me of Sundays with my brothers and father.
      On the other hand, the NFL’s efforts to prevent head injuries don’t qualify as serious in my opinion. Moreover, the NFL pays millions to individuals; some of whose values, or lack thereof, and actions, some frankly criminal, are abhorrent to me. Accordingly, I try my best to not support the NFL. I don’t watch the commercials during football games, buy team paraphernalia, or go to games. But I have basic cable TV, which includes NFL games, in my home. And I subscribe to my local newspaper which covers the local NFL team. I also subscribe to the New York Times which covers NFL games along with the issues around football players’ safety. Which of those actions make me complicit in the NFL’s actions? Is this really any different from the fact that I often buy goods made abroad? Am I guilty of complicity because my home is comfortably heated right now by a utility company whose actions have greatly harmed the environment and in turn endangered people’s lives now and in the future?
      In sum, I think that trade-offs are intrinsic to modern life. We are so completely dependent on large corporations with myriads of actions – seen and unseen, that the harm produced by watching football is on a par with the harm that any participation in modern life produces. The only way to avoid ethical compromises is to go off the grid and live a hermit’s life. And even then….


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