Chronic traumatic encephalopathy warns neurosurgeons that it is a “time bomb of justice”

Concussion in sports is the subject of taboo. ETC or chronic traumatic encephalopathy that can result from concussion is even more serious. If this pathology is better and better known, it is still rare on a national scale. However, the concussion damage and the subsequent sequelae are clearly visible.

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Clermont-Ferrand’s neurosurgeon, Janchazal, one of the first to warn of the dangers of shock violence in sports and the author of the book This rugby to kill (Solar version) Back in franceinfo: the sport of this illness, the consequences, and how sports organizations take it into account.

Franceinfo: Sports: What is Chronic Traumatic Encephalopathy, also known as ETC?

Jean Chazal: It is the most horrifying result of repeated concussion. Concussion is the result of head trauma and causes brain dysfunction. During this trauma, the brain is shaken in the cranial box. Imagine the brain as gelatin. If you shake the box that contains it, it will crack and dislocate extremely. The same is true for the brain.

“The brain is under construction until the age of 25.”

Jean Chazal, Neurosurgeon

France Information: Sports

ETC is affected by the threshold effect. You can have three, four, or five concussions without any clinical or very temporary problems. After intellectual and physical rest, the patient recovers, and one sunny day, after a new concussion, he no longer recovers. However, ETC can occur well 10 or 15 years after one or more concussion, and one day symptoms appear. It is possible to evolve into a dementia or pseudo-dementia state. It’s unpredictable.

The symptoms of ETC are very diverse. Headache, malaise, sensitivity to noise and light, insomnia, mood disorders, concentration, balance, sleep, memory loss, depression, etc. Therefore, diagnosis can be complicated.

Yes, some patients have more or less proven memory problems, which can be very frustrating, for example. These symptoms can interfere with your daily life, but they are not enough to take them seriously.

Doctors usually classify this into age, personality, lifestyle, or another medical condition. And it’s often relatives to challenge them by saying, “I don’t recognize him anymore.” It’s very nice, and it makes expertise difficult. Diagnosis of ETC requires a wealth of experience.

Even if ETC is recognized by the scientific community in France, it is not well known to doctors. It goes without saying that detection is complicated.

Yes, especially in the field of sports, it is potentially a judicial time bomb. The problem is expertise. There are many doctors and specialists who do not always have good experience with this condition, its causes and its mechanisms. Three years of post-wisdom can be justified to conclude the expertise in the field of cranial traumatology.

“At the first concussion turn, the image may not reveal anomalies.”

Jean Chazal, Neurosurgeon

France Information: Sports

After a head injury that leaves sequelae, there is first expertise in T0, then 6 months, 1 year, and finally 3 years. During this period, tests, especially neuropsychological tests and controlled MRI, will be performed. Next, it should be compared to previous tests performed after the first symptoms appeared. At the first concussion turn, the image may not reveal a significant anomaly.

Ideally, the software should be used to perform specific MRI sequences to reveal microlesions such as tractography. This process can show multiple bundles that allow neural traffic (electric current) to flow from one part of the brain to another. Following one or more concussion, one or more ruptures of these bundles may be observed. It is clearly a significant abnormality and is a true brain lesion that explains brain dysfunction and thus certain symptoms.

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However, it is mostly research, and so far there is not enough systematic or case study to draw conclusions. However, as we get older, for example around the age of 40 or 50, the cerebral atrophy that is ultimately caused by repeated concussion is very well distinguished by conventional MRI. Therefore, it is a very long-term and very detailed task. And unfortunately it’s not done systematically.

What is the cause of this?

I myself am an expert, and I can clearly see that the files are often incomplete and the expert reports are only 3-4 pages long. They were not completely competent and were written by a doctor who knows everything we are talking about. In their defense, the files are sometimes poorly documented and notified. For example, experts, doctors, and the Social Security Administration say, “Everything this player is suffering from (insomnia, mood disorders, etc.), I have no evidence, so I won’t be incapacitated.” I have already heard. Even though he suffered a concussion.

My intention is not to criticize my colleagues, but to insist on raising awareness of the problem and strengthening training by relying on a few expert colleges in difficult cases. am. It’s a serious public health and sports issue and I think we should go further.

“The problem is actually the sports business.”

Jean Chazal, Neurosurgeon

France Information: Sports

Also, do you want to say that ETC is taboo in France?

Some clubs have some kind of denial and bloody rules for financial reasons. Beyond the fact that few doctors are properly trained, they can be under pressure from club presidents and national and international rugby governing bodies.

I was an expert in rugby league. From 2017 to 2018, I participated in the National Astronomical Observatory of Health for Rugby Players of the Federation. After that, I was no longer invited. why ? I talked too much about the dangers of this sport and wrote a book following this mission. This rugby to kill (Solar version), here details everything I have just explained to you. I also explain that four players died shortly after the match. Meanwhile, they were suffering from too much trauma. So I was told: “It’s not worth it anymore and you should no longer express yourself on the subject.” But instead of putting myself off, I keep saying what I think.

In this book, we will talk about this judicial time bomb, ETC. The problem is actually the sports business. If ETC is recognized without a reservation, many players will seek relief, which is economically costly. I think the club president knows this, but they are not responsible because they run the club on their own, sometimes even at the professional level. They are not doctors. Responsible are the Governing Body, the All-Union, and World Rugby. And I think the Ministry of Sports and the Ministry of Social Affairs and Health need to investigate this issue more carefully and accurately.

To be precise, are there any clues to limit concussion and thus limit athletes’ ETC cases?

There is no fundamental solution. One thing I can say strongly is that the only real cure is prevention. So people will tell me that these sports have always existed and there has always been a concussion. Yes. However, the difference is that the player was much lighter and weaker than it is today and did not have the hypertrophied muscles (abnormal increase in tissue volume here) as it does today. In their amateur days, they ran at 25 km / h, but today we are already timing professional players to clock in at 36 km / h.

“Equipped with a 500 horsepower engine in a 4L chassis”

Jean Chazal, Neurosurgeon

France Information: Sports

Imagine a player weighing over 100 kg (common these days) colliding with an opponent who weighs less than 20. At this speed, the force deployed and maintained is considerable and the damage can be horrific. We placed a 500 horsepower motor (that is, hypertrophied muscles) in a 4L frame (bones, tendons, and joints remain the same without hypertrophy). The brain remains the same and there is no protection to withstand such trauma.

However, World Rugby implemented a concussion protocol at the beginning of the 2014-2015 season to protect players.

Yes, World Rugby and FFR have set up diagnostic protocols. When a player is a victim of a head injury, he is inspected on the pitch at H + 6, H + 48. If a concussion is confirmed, he will rest completely. When all symptoms have healed and this is usually unavoidable, he will be able to return to the scene.

The problem is that you can make a head in soccer all year round or you can inflict mild head injuries all year round in rugby. These are called subcontractive states. Today, we find that these “well-supported” traumas cause accumulating microlesions, and one day these individuals develop dementia or pseudodementia syndrome in multiple forms already listed. I have.

“When the brain weakens between the ages of 20 and 30, it ages prematurely.”

Jean Chazal, Neurosurgeon

France Information: Sports

why ?

When the brain weakens between the ages of 20 and 30, it ages prematurely. He accumulated microlesions without any obvious or annoying symptoms. Physiological aging accelerates abnormally with the discontinuation of sports, consumption of tobacco and alcohol, overweight, arterial hypertension, and an increase in microlesions.

The medical science literature has fully demonstrated that the incidence of degenerative diseases such as Alzheimer’s disease and Parkinson’s disease is significantly higher in top athletes with head injuries. It is also acknowledged that after practicing boxing today, 15% of boxers suffer from early dementia-like disabilities at the end of their lives.

In today’s professional rugby, it is recognized that players can suffer up to 3-4 concussion between the ages of 20 and 30. On average, it is believed that there are 10 concussion per 1000 players per hour. This represents a concussion every 3-4 games of rugby. On the top 14 weekends, it means there are at least 3 or 4 concussion. That’s a lot.

For some, we know that this ends up in ETC and we can’t reliably make case-by-case predictions. Some players will escape it without knowing the exact scientifically proven reason. However, we know that risks exist and are not negligible, and the onset of symptoms can dramatically change the lives of players and their families.