Dr. DiFiori presented to us a series of studies regarding repetitive mild traumatic brain injury in mice animal models and the presence of proteins released from sheared microtubules such as tau and beta amyloid. The presence of these proteins and their relation to chronic traumatic encephalopathy found in contact sports athletes, and neurodegenerative diseases such as dementia and Alzheimer’s, give rise to many questions about preventative measures and treatment. How can we protect contact sport athletes from developing CTE? Is there any way to repair the damage done from a mild traumatic brain injury, and prevent further injury from being more damaging then the first?
Dr. DiFiori’s focus on the “vulnerable window” could be the start to answering at least some of these questions. From his research on animal models studies and implementing his findings in his patient care protocol of the football players at UCLA, Dr. DiFiori and his colleagues have found that there is a window of time where re-injury could be the most damaging, if a player returns to play too soon. This is due to the window of time it takes for regular metabolic function to return to the brain. As we have learned from Brain and Behavior, the brain accounts for the use of about 25% of the body’s metabolic function. As Dr. DiFiori mentioned, a return of cerebral blood flow of normal glucose and glutamate levels takes roughly 7-10 days. With that in mind, in most of the animal model studies mentioned in the presentation, there was a peak at 3-5 days where another closed-headed injury caused heightened symptoms and increased damage to the brain; whereas a repeated injury at 7 days after the initial injury reported that histological and cognitive symptoms were no more severe than the initial injury.
This finding should be enough to pull athletes off the field at even the suspicion of brain injury. Coaches, athletic trainers and team physicians should be mindful that at collegiate and professional level, athletes are extremely competitive and less likely to report symptoms if it means staying in the game. Although 7-10 days in an athlete’s career or season may seem like forever, the risks of permanent brain damage in their later lifetime will keep them sidelined from much more. An interesting point made by Dr. DiFiori reminded me of something I had recently seen online. Besides the fact that concussions themselves should never go ignored or unreported, he mentioned that concussions could be the gateway to discovering more severe brain and spinal injuries. Recently, I watched the Tuft’s men’s lacrosse team’s documentary on their road to the national championship of their 2015 season. Their program is one of the best in the country, having won the NCAA National Championship for Division III back to back the past two years. This past season, the Jumbos’ leading scorer and returning All-American attackmen was knocked unconscious with what was believed to be a pretty high-grade concussion. After some complaining of numbness in the fingers and toes and careful observation by the athletic trainer, some testing was done and Chris Schoenhut was diagnosed with spinal stenosis. A blow to the lower back on the field could cause irreversible damage. Though his athletic career as a Jumbo has now been cut short, Chris’ future quality of life has been preserved because of this discovery. All because a trainer and a coach did not allow him to return to play after a suspected concussion and gave him the appropriate medical care he needed. As I was listening to Dr. DiFiori present, it reminded me of this discovery, and the incredible importance and responsibility that medical professionals have, at any level, to give their patients the best care possible – even if that means pulling them off the field for an extra 7-10 days.