NCAA Settlement Overhauls Head-Injury Policies (Chronic traumatic encephalopathy)

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N.C.A.A. Settlement Overhauls Head-Injury Policies

http://www.nytimes.com/2014/07/30/sports/ncaa-settlement-overhauls-head-injury-policies.html?_r=0

The N.C.A.A. has reached a preliminary settlement in a class-action lawsuit brought by former college athletes to institute wide-ranging reforms to its head-injury policies.

The settlement is the latest attempt by the N.C.A.A. to address concerns over athletes’ rights. It brings a significant change in the care and safety of all current and former college athletes — male and female, in all sports and across each division — including a $70 million medical monitoring fund and a new national protocol for head injuries sustained by players during games and practices.

“This offers college athletes another level of protection, which is vitally important to their health,” said the lead plaintiffs’ lawyer, Steve Berman. “Student-athletes — not just football players — have dropped out of school and suffered huge long-term symptoms because of brain injuries. Anything we can do to enhance concussion management is a very important day for student-athletes.”

The settlement, which was filed in federal court in the Northern District of Illinois on Tuesday morning and still requires the approval of Judge John Z. Lee, would establish a medical monitoring fund similar in some ways to the one proposed recently by the N.F.L. and the N.F.L. Players Association.

It would give all former college athletes a chance to receive a neurological screening to examine brain functions and any signs of brain damage like chronic traumatic encephalopathy, a degenerative brain disease.

The N.C.A.A. would also prevent athletes who have sustained a concussion from returning to a game or practice that day. Trained medical personnel would be required at all contact sports events like football, lacrosse, basketball, soccer and wrestling.

“This agreement’s proactive measures will ensure student-athletes have access to high quality medical care by physicians with experience in the diagnosis, treatment and management of concussions,” Brian Hainline, the chief medical officer of the N.C.A.A., said.

A key distinction in the N.C.A.A.’s settlement in comparison with the N.F.L. agreement is that college athletes would preserve their rights to sue their universities or the N.C.A.A. for personal-injury financial damages. The N.F.L.’s agreement, which is pending approval, seeks to create a fund worth several hundred million dollars to assist former professional football players with treatment for the effects from their brain injuries. The N.C.A.A.’s settlement covers only diagnostic medical expenses.

While there are about 4,500 former N.F.L. players, there are close to four million former college athletes, and 1.4 million in contact sports. Their experiences vary drastically, Berman said, making monetary damages difficult to address.

“It’s hard to create one class that includes swimmers and football players, given how different their athletic careers are,” said Berman, who added that the N.C.A.A., too, wanted only to discuss policy changes rather than financial rewards. “We felt individuals remain best off bringing individual suits, which they can still do.”


Several cases criticizing the N.C.A.A.’s handling of concussions began in 2011 when the former Eastern Illinois football player Adrian Arrington said the N.C.A.A. had been negligent in educating and protecting him after he sustained multiple concussions. Derek Owens, a wide receiver at Central Arkansas, soon brought his own suit, as did a female soccer player and a hockey player. Thirteen similar lawsuits were consolidated earlier this year.

According to N.C.A.A. documents uncovered during discovery, there were more than 30,000 concussions at colleges from 2004 to 2009. Describing the organization’s concussion policy, the N.C.A.A.’s director of health and safety, David Klossner, wrote in a 2010 email to a colleague: “Since we don’t currently require anything all steps are higher than ours.”

“A national policy is a very good thing,” said Matthew J. Mitten, the director of the National Sports Law Institute and the former chairman of an N.C.A.A. committee on safety. “We were only able to make simple recommendations, but now there is consensus among the athletic and medical community. The trick will be enforcing it at every school and not just at Ohio State and U.S.C.”

Settlement talks occurred during four meetings over the last year (three with the same judge who mediated the N.F.L.’s concussion settlement). Other terms of the agreement include $5 million for concussion research, to be funded by the N.C.A.A. and its member schools (the $70 million monitoring fund would be paid for by the N.C.A.A. and its insurers). Increased concussion tracking by schools and a preseason baseline test for every athlete would also be required.

To qualify for a neurological exam, former athletes must complete a questionnaire designed by a team of neurologists and concussion experts.

Should players qualify and need additional treatment, they can seek it through their own insurance or file a damages claim.

Owens and Arrington, for example, will continue their suits against the N.C.A.A.

“I don’t think there’s been much done in this regard before,” said Owens, who said he continues to have anxiety and depression after multiple concussions during college. “Not only for old washed-up guys like myself, but the current players and all the players who are going to come to school.”

Berman said he expected the $70 million would hold up for the life of the 50-year agreement because testing for C.T.E. and other brain diseases should become cheaper. The new diagnostic testing should also eliminate the need for future athletes to need postcareer screenings, he said.

“I’m cautiously optimistic,” said Dr. Jeffrey Kutcher, a neurologist at the University of Michigan. “It’s a good step; it’s a needed thing. But C.T.E. is very difficult to diagnose, and the medical monitoring is only as good as the quality of the evaluations these athletes receive.”

The settlement is the latest measure taken by college sports’ governing body in the face of a host of lawsuits and public critiques, echoing from Capitol Hill, where both the House and the Senate held recent hearings examining the N.C.A.A., to college campuses around the country.

If the preliminary settlement, which includes no admission of guilt or wrongdoing by the N.C.A.A., is approved by Lee, an open comment period for current and former college athletes will follow before final approval. That process could take as long as five months.
 

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http://www.cnn.com/2017/07/25/health/cte-nfl-players-brains-study/index.html

CTE found in 99% of studied brains from deceased NFL players
By Daniella Emanuel, CNN


Updated 2:57 PM ET, Tue July 25, 2017

Now PlayingWhat is CTE?
Source: CNN

What is CTE? 01:55
Story highlights

  • Chronic Traumatic Encephalopathy (CTE) was found in 110 of 111 brains of deceased former NFL players
  • The study is the largest of its kind, examining 202 brains of former football players in total
(CNN)Chronic traumatic encephalopathy, known as CTE, was found in 99% of deceased NFL players' brains that were donated to scientific research, according to a study published Tuesday in the medical journal JAMA.

The neurodegenerative brain disease can befound in individuals who have been exposed to repeated head trauma. The disease is pathologically marked by an buildup of abnormal tau protein in the brain that can disable neuropathways and lead to a variety of clinical symptoms. These include memory loss, confusion, impaired judgment, aggression, depression, anxiety, impulse control issues and sometimes suicidal behavior.


5 things to know about CTE

It can only be formally diagnosed with an autopsy, and most cases, although not all, have been seen in either veterans or people who played contact sports, particularly American football.
"There's no question that there's a problem in football. That people who play football are at risk for this disease," said Dr. Ann McKee, director of Boston University's CTE Center and coauthor of the new study. "And we urgently need to find answers for not just football players, but veterans and other individuals exposed to head trauma."
The JAMA study is the largest of its kind and all of those studied were required to have football as their primary exposure to head trauma. The criteria for submitting a brain was based on exposure to repetitive head trauma, regardless of whether that individual exhibited symptoms during their lifetime.


Aaron Hernandez's brain will be examined for CTE

The study points out potential bias because relatives of these players may have submitted their brains due to clinical symptoms they noticed while they were living. It also acknowledges the lack of a comparison group that represents all individuals exposed to college-level or professional football. Without that, the study lacks an overall estimate on the risk of participation in football and its effects on the brain.
Out of 202 deceased former football players total -- a combination of high school, college and professional players -- CTE was neuropathologically diagnosed in 177, the study said. The disease was identified in 110 out of 111 former NFL players. It was also found in three of the 14 high school players and 48 of the 53 college players. The study included brains of individuals who have been publicly confirmed to have had the disease, including Ken Stabler, Kevin Turner, Bubba Smithand Dave Duerson.
"The medical and scientific communities will benefit from this publication and the NFL will continue to work with a wide range of experts to improve the health of current and former NFL athletes," the NFL told CNN in a statement, noting that "there are still many unanswered questions relating to the cause, incidence and prevalence of long-term effects of head trauma such as CTE."


NFL acknowledges CTE link with football. Now what?

In 2016, the NFL publicly acknowledged for the first time a connection between football and CTE. In June 2015, a federal judge approved a class-action lawsuit settlement between the NFL and thousands of former players, providing up to $5 million per retired player for serious medical conditions associated with repeated head trauma.
"The NFL is committed to supporting scientific research into CTE and advancing progress in the prevention and treatment of head injuries," the NFL statement on the study said. "In 2016, the NFL pledged $100 million in support for independent medical research and engineering advancements in neuroscience related topics. This is in addition to the $100 million that the NFL and its partners are already spending on medical and neuroscience research."
Questions raised
The study examined both the brain pathology -- which is the behavior of the disease in the brain --and clinical history of every participant. It identified four stages of pathological CTE severity among the brains, based on amounts of tau buildup and distribution. Stages one and two are considered to be mild and stages three and four are considered severe.


Inflammation in the brain linked to CTE

Individuals who were reported to have experienced more behavioral mood symptoms during their lifetime were more likely to have findings indicative of mild disease as opposed to severe. These symptoms occurred in 96% of mild cases and 89% of severe cases. People with a mild build up and distribution of tau were also more likely to have died by suicide. Those with a more severe build up, on the other hand, were more likely to have experienced cognitive symptoms, such as memory loss.
The behavioral and mood symptoms in people with mild disease evidence may be the result of other influences, such as neuroinflammation or axonal injury, which is an injury to the brain cells, McKee said. The question of pathology's relationshipto clinical symptoms is one they're hoping to answer in future studies, she said.
Dr. Jeffrey Kutcher, national director of the Sports Neurology Clinic at the Core Institute, who was not involved in the study, agreed with the need to further understand this relationship.
"Just because we are describing the same CTE pathology, the collection of tau and the distribution that's consistent with CTE, that doesn't mean it's the only pathological process," Kutcher said. "There could be others that we are yet to identify. So I think its important that we don't just focus on one pathology, and that we start looking for others."
Seeking help
Studies like this have the potential to create a powerful narrative for football players who read them, but may not have a full understanding of the science or the bias in the sample, Kutcher said. This could lead players to believe that they are damaged and that there is no use in seeking help, he said.
"To me, that is one of the biggest issues we have right now," Kutcher said. "Not emphasizing that people should seek treatment for their problems."


Former NFL player Kevin Turner diagnosed with CTE

Although the disease cannot be formally diagnosed until after death, many of the symptoms of CTE that may be experienced during a lifetime, such as depression or anxiety, are treatable, Kutcher said. That is why its important for someone experiencing these symptoms to access a comprehensive evaluation by a neurologist, and work with them to figure out a treatment plan.
Kutcher said its also important to consider that the brains examined in the study came from players who played decades ago. Most of the participants with CTE played football during the 1950s, '60s, '70s, '80s and '90s, McKee said, with the rest having played in the 2000s and 2010s.
The experiences of the majority were different from those who play the sport today, Kutcher said, and there was not the same awareness, medical protocols or equipment to prevent brain injuries.
"My rule as a physician, as a neurologist, is to protect and promote the brain health of my patients over the course of a lifetime, no question about that. You have to look at the total person though," Kutcher said. "You have to understand why people play sports. It's an individual decision, everybody gets different things out of it. You also have to understand what the arc of their life is going to be, what their health is going to be at the end of their career."
Next steps
McKee and her colleagues are currently working to understand more about CTE and who is most susceptible to it. They are looking at the lengths of exposure to head trauma, the age of first exposure, the lengths of playing careers and how that relates to the risk of CTE and its pathological severity, she said.
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"It certainly can be prevented and that's why we really need to understand how much exposure to head trauma and what type of head trauma the body can sustain before it gets into this irreversible cascade of events," she said.
They are also using the 177 donated brains with CTE to try and see if there are any genetic risk factors of the disease.
"For the first time, we've established this really rich resource, not only of data, both the clinical symptoms and the pathological features, but also a tissue resource to enable future research in CTE," McKee said. "And we know that this study doesn't answer many of the very important questions in CTE, but the resource will help us understand the molecular underpinnings, will help us develop biomarkers and therapies by understanding the pathological features of the disease."
An earlier version of this story incorrectly stated that this is Concussion Awareness Week. It is Major League Lacrosse Concussion Awareness Week.
 
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