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The brain is the final frontier. Although much scientific research has been done toward trying to understand it, research funds haven't kept up with basic research needs, and we have only taken the first small steps in exploring this grey-and-white miraculous organ.
Because there is so little factual knowledge in comparison to what is yet to be learned and because it will probably take decades before we truly begin to understand the brain, we need to apply logic and reason in our thinking about many aspects of brain function and brain injury in order to start to make sense of the mysterious and in order to point the way to profitable paths of exploration. In the consideration of chronic traumatic encephalopathy, there seems to be a dearth of logic and reason.
“Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease found in people who have had multiple head injuries. . . . Most documented cases have occurred in athletes involved in contact sports such as American football, wrestling, boxing, ice hockey, rugby and soccer. Other risk factors include being in the military, prior domestic violence, and repeated banging of the head. The exact amount of trauma required for the condition to occur is unknown. Definitive diagnosis can only occur at autopsy. It is a form of tauopathy.
“As of 2018, there is no specific treatment. . . . Research into brain damage as a result of repeated head injuries began in the 1920s, at which time the condition was known as dementia pugilistica or "punch drunk syndrome".” (Wikipedia)
“Tauopathies are a class of neurodegenerative diseases associated with the pathological aggregation of tau protein in neurofibrillary or gliofibrillary tangles in the human brain.” (Wikipedia)
What happened to Muhammed Ali after a life of skilled boxing is the logical consequence of the brain being thrown against the jagged, rough inside surface of the skull. Where and how hard the head is hit will determine which parts of the brain are most affected. Punch someone straight onto the forehead, and their brain will ricochet off the inside of the back of their skull, then bounce off the front inside of it. That’s the visual cortex, the cerebellum, and pre-frontal cortexes smashed for you. Sock a man over his ear, and the two temporal lobes will hit rough bone. That’s why no two brain injuries are alike, yet the long-term consequence will probably look like CTE, sometimes recognized, sometimes not as stemming from brain injury, depending on any number of factors ranging from the person’s resiliency to the number of concussions to how much if any treatment the person received and if treatment reverses the risk of developing what clinicians currently think is CTE. That last is the key. And it’s an unknown because standard medical care doesn’t treat the neurons.
At the moment, standard care seems to be to wait and see what happens over time after a concussion or brain injury. It’s the opposite of healing wounded skin. In that case, the physician will stitch up the wound to minimize scarring, not wait first to see if the person has excellent self-healing skin or skin that scars into thick ropes that become infected easily. Likewise with brain injury, it's logical to assume, given observations of how some "scar" little while others "scar" a lot, people who seem to recover may actually show that small amount of scarring through perhaps seemingly small memory or concentration changes or slight change in speech patterns or maybe they don't like to read anymore or they're a little less patient than they used to be. As they age, their brains may deteriorate quicker than expected, but most won't connect a long-forgotten concussion to the dementia. We don't know if CTE is really untreated brain injury because current focus is on studying CTE as some sort of syndrome that is unrelated to not treating brain injury instead of on challenging assumptions that seeming recovery is real recovery.
Assuming the concussion doesn’t “resolve,” the standard care is to rest, teach strategies, and advise the patient to accept the injury. It would be like if an oncologist intoned the bad news to their patient then prescribed nothing as treatment — “I’m afraid to tell you that you have a tumour in your stomach. It’s fatal. But I’m sure that with rest at home, some strategies the occupational therapist will teach you about how to eat with a growing lump of flesh in your stomach, some pain medications to dull a common symptom, that you’ll be fine.”
Medically we know that anything that goes untreated leads to worse problems.
A tumour becomes death. A blocked artery becomes a heart attack. A broken bone becomes a misshapen leg that leads to posture problems and chronic pain in knees, hips, spine, and neck. Do we then investigate the chronic pain as if it had nothing to do with the unmended broken bone? No, we mend the bone better and research better ways to heal bones. Do we investigate heart attacks as if they’re divorced from blocked arteries? No, we investigate and open the blocked arteries and learn how to prevent them blocking. Do we investigate the death as if the tumour and lack of treatment didn’t cause it? No, we sink millions into reducing cancer’s fatality rate and clinicians expand their treatment vocabulary so as to give their patients the best chance at life and a good quality life at that.
Brain injury, seemingly alone, is left untreated as if that is good medicine. Rest is not treatment. Rest between treatments is part of a treatment protocol. Strategies are not treatment. Strategies while treatment commences is part of coping during the healing process. Acceptance shouldn’t be about accepting poor medical care. It should be about accepting that the injury occurred and that treatment is necessary and hard work.
Dr. Bennet Omalu did a great service for everyone with brain injury. But he investigated and revealed the end stage of brain injury: CTE.
Punch drunk doesn’t happen out of the blue. It happens because boxers hit other boxers’ heads and their brains die little deaths each time. Punch drunk wouldn’t happen if heads weren’t being hit in sports, falls, car crashes, you name it. And it may not happen if those bashed brains were healed each and every time they were injured. And in the future it won’t happen once we share and learn more about how to heal sheared axons, ripped neurons, and bleeding blood vessels at the moment of injury.
And do it.
Every time.
For everyone.
Copyright ©2018 Shireen Anne Jeejeebhoy. May not be reprinted or reposted without permission.
