Neuroclinic

Originally posted on CNN’s website by Nadia Kounang, CNN

Nathan Stiles died playing the game he loved, football.

Dr. Sanjay Gupta has been following the 2011 season of a North Carolina high school football team. In 2008, a player on the team died after sustaining a head injury during a game. For a closer look at the health and safety issues on the playing field, watch “Dr. Sanjay Gupta Reports: Big Hits, Broken Dreams,” premiering January 29, 2012, at 8 p.m. ET.

(CNN) — For 17-year-old Nathan Stiles, his senior year was supposed to be the best yet.

He was a straight-A student and homecoming king at Spring Hill, Kansas, High School, and was the Broncos’ star running back. He was a starter on the varsity basketball team and loved to sing at church. He was the son any mother dreamed of having.

His mom, Connie, recalls, “He was an athlete, but school was important. His grades, his teachers and just having a family … he had his priorities right.”

The final game of his senior year turned out to be the final game of his life. Nathan died playing the game he loved, football. His autopsy would reveal he died of second-impact syndrome, when a player is hit again before the brain has had a chance to heal from an initial concussion.

But it would turn out that those repetitive hits Nathan took on the field would also make him the youngest reported case of chronic traumatic encephalopathy (CTE). It’s a degenerative disease found in football players and other athletes in contact sports who get repeated hits to their heads.

Nathan Stiles was a straight-A student, homecoming king, and the Spring Hill Bronco’s star running back.

Nathan Stiles was a straight-A student, homecoming king, and the Spring Hill Bronco’s star running back.

The day after homecoming, Nathan complained of headaches. But nothing unusual, until five days later, when his mom received a call from his athletics trainer. “Nathan’s telling me he’s still having headaches. You need to go take him to the emergency room.’”

And so Connie did. Nathan had a CT scan and the doctors reported a clean bill of health. Yet, to be on the safe side, doctors kept him out of play for three weeks.

Kansas is one of 34 states that require a player to be cleared by a health care professional before they return to play. In addition, Kansas also requires that players and their parents sign a waiver acknowledging the risks of concussions.

When Connie and Nathan returned to the doctor’s office three weeks later, Connie remembers Nathan turning to her and asking “Now, Mom, are you OK with this?” She didn’t want him to, but it was hard for her to say no. “You know, it’s his choice,” she said.

His first game back, Connie remembers him getting hit. “I saw him kind of get stunned. But he walks out and tells Ron, ‘Oh I’ve never felt better, that was the best game, I never felt so good.’” He even took his ACTs the following day and had no complaints. The headaches that had bothered Nathan several weeks before were gone, or at least appeared so to his parents.

The following week was the final game of his career. Nathan intercepted the ball and sprinted toward the end zone. Touchdown. “If you would watch him run, he had a flow about him that was just beautiful. I mean it looked so graceful,” remembers his dad, Ron.

Big hits, broken dreams Explain it to me: Concussions Parents see their son’s brain damage Ex-NFL players talk about concussions

But right before halftime, his parents noticed Nathan was acting strangely. “I watched him walk off the field, and I said, ‘He’s walking funny.’ I mean, I know that kid so well,” said Connie. Her phone rang. It was someone on the bench by Nathan.

“Get over here. Something’s wrong,” she heard.

By the time Ron and Connie made it to the bench, it was too late. Nathan had collapsed on the sidelines. His mother rushed to his side, trying to get him to wake up. “Come on buddy, it’s your mama, come on!” she urged. But instead of waking up, Nathan began seizuring.

He was airlifted to Kansas State University Medical Center, some 50 miles away, and rushed into surgery. Four hours later, the doctors came out to tell Ron and Connie they stopped the bleeding in his brain, but Nathan’s lungs and heart were too weak to go on.

By 4 a.m. the following morning, Nathan was off life support.

Nathan’s autopsy revealed he died from multiple hits to the head, also known as second impact syndrome. As Ron and Connie tried to determine what was next, Ron received a call he never expected. “You know when you get a telephone call after your son dies saying they want your son’s brain, sometimes that’s a hard call to get.”

On the other end of the phone was Chris Nowinski, one of the co-directors of the VA Center for the Study of Traumatic Encephalopathy Brain Bank. The Brain Bank is a joint project between the Department of Veterans, Boston University, and the Sports Legacy Institute. Their missions is to understand what those hard hits on the field are doing to the brain, by looking inside the brain.

Nowinski spends his time tracking football and sport related deaths and having to make the difficult calls to their families. “I have called hundred of families within 48 hours of their loved ones dying, and it’s never easy.” Instead he focuses on the fact that the bank’s work will protect families in the future. “I hate every call we make, but you know, I honestly, I have to prep and think of the positives that come out of it.”

The Brain Bank is the world’s largest collection of athlete brains. Since its inception in 2008, the bank has documented over 50 cases of CTE. Much of that work is in the hands Dr. Ann McKee, the bank’s co-director and neuropathologist. She actually dissects the brain to track the trauma in the brain, and what she’s finding in the brains of some players in their 40s and 50s is astonishing.

“You expect a pristine brain. I saw a brain that was riddled with tau proteins. I was stunned at how similar that brain was to the boxers who lived into their 70s,” she said. Tau proteins are the same type of proteins found in brains of Alzheimer’s patients.

But to see the same type of damage in 17-year-old Nathan Stiles’ brain was something that surprised even McKee. It’s the youngest case she’s documented, and for her, a call to action. “It tells you that we’ve really got to protect our kids,” she said. “It’s not just car seats and seatbelts, but it’s making sure that when they go out to play sports that we take proper precaution and we give them proper advice.”

And that means making sure that athletes take the time to recover from concussions, and making sure they aren’t playing symptomatic, while having headaches or memory problems.

For Ron and Connie Stiles, the findings and the warnings were too late to save their son. But Ron knows that Nathan’s legacy will live on as researchers learn more about concussions and how to treat them.

“I think there are some issues that need to be looked at, and I think that’s happening,” he said. “And I think that Nathan is helping that.”

By ALAN SCHWARZ
Originally Published: July 26, 2010

The National Football League is producing a poster that bluntly alerts its players to the long-term effects of concussions, using words like “depression” and “early onset of dementia” that those close to the issue described as both staggering and overdue.

The poster, soon to be hung in locker rooms leaguewide, becomes by far the N.F.L.’s most definitive statement on the cognitive risks of football, which it had discredited for most of the past several years as academic studies and reports of deceased players’ brain damage mounted.

The new document also warns players that repeated concussions “can change your life and your family’s life forever,” a clear nod to retired players’ wives who have spoken out on the issue, occasionally before Congress. A draft of the poster also features photographs of unnamed youngsters in various sports with the reminder, “Other athletes are watching.”

The new poster, which will also become a brochure given to all players, presents a stark change in league approach. It replaces a pamphlet given since 2007 that said, “Current research with professional athletes has not shown that having more than one or two concussions leads to permanent problems if each injury is treated properly,” and also left open the question of “if there are any long-term effects of concussion in N.F.L. athletes.”

The sobering new warning could affect not just the behavior of current N.F.L. players and youth athletes, but also how retired players’ claims of cognitive decline are handled under the disability plan operated jointly by the league and the players union.

“That poster is shocking,” said Domonique Foxworth, a cornerback for the Baltimore Ravens. “It gives people facts before they take risks. But it’s not exactly a new revelation.”

Matt Birk, the Ravens’ center, said: “To put it out there in writing in locker rooms, at least it’s publicly acknowledging that, ‘Hey, this is real.’ There’s risks in everything you do, and this one is real. You can’t sweep it under the rug anymore.”

Greg Aiello, a league spokesman, said in an e-mail message that the poster, spearheaded by the league’s new head, neck and spine medical committee and written in collaboration with the players union and the Centers for Disease Control and Prevention, “is intended to present the most current and objective medical information on concussions and will be distributed to the players and clubs in the near future.” He said Commissioner Roger Goodell provided his full support.

“We took a very firm stance,” said Dr. Thom Mayer, the union’s medical director and a member of the committee who worked on the text. “This is a clear step forward in educating players.”

The poster lists symptoms that players should look out for, including headaches, confusion, memory problems and feeling more emotional, and warns them not to ignore symptoms.

Beyond detailing the symptoms and severity of head injuries, the poster extends the league’s broad redirection in concussion policy since last fall. Then, the league adopted stricter rules regarding when players can return from head injuries, and then only with an independent neurologist’s permission.

Other changes to playing rules, practice procedures and equipment are being considered, with history suggesting that alterations could be adopted at the college and youth levels.

The new language is a glaring departure from words used by the league’s old concussion committee, whose comments and research that played down the evidence of concussion risks eventually led to its chairmen’s resignations. Their successors, who directed the poster project, Dr. H. Hunt Batjer and Dr. Richard Ellenbogen, did not return phone messages Monday.

The league’s reversal is not necessarily complete. On April 30, an outside lawyer for the league, Lawrence L. Lamade, wrote a memo to the lead lawyer for the league’s and union’s joint disability plan, Douglas Ell, discrediting connections between football head trauma and cognitive decline. The letter, obtained by The New York Times, explained, “We can point to the current state of uncertainty in scientific and medical understanding” on the subject to deny players’ claims that their neurological impairments are related to football.

Mr. Lamade did not return a message left Monday at his law firm, Akin Gump Strauss Hauer & Feld in Washington. Mr. Aeillo said the league would comment on the letter at a later time.

Brent Boyd, 53, a Minnesota Vikings lineman in the 1980s, is among scores of players whose symptoms of early-onset dementia have been ruled ineligible for the considerably higher disability payments given to players with on-field injuries. That denial took place soon after the last of three plan-chosen doctors ruled in 2001 that a particular concussion Boyd sustained “could not organically be responsible for all or even a major portion” of his condition.

Denied the higher benefits by the disability board, Mr. Boyd has been fighting to reverse the decision ever since. Two months ago, another of his appeals was denied because, the reply noted, “There are no changed circumstances,” and Mr. Boyd refused to see a fourth doctor.

Mr. Aiello and a union spokesman, George Atallah, declined to discuss any possible effect the new poster might have on disability claims. Most likely, the onus will remain on players to assert that their individual conditions did derive from professional football — similar to how players must handle worker’s compensation claims — although that assertion could gain credence with the league’s imprimatur.

Meanwhile, the most immediate effects of the new poster could be on the mind-set of current and future players. Mr. Birk said that some players would still try to play through head injuries “because the culture is so strong, but it’s a good start.”

Mr. Foxworth said: “Ninety-nine percent of the people who put helmets on don’t get the payback we do, but they’re taking the same risks. It’s probably more valuable to them than it is to a lot of us.”

Chris Nowinski, a co-director of the Sports Legacy Institute and an advocate for youth concussion awareness, said he was relieved to learn about the new language. “The old pamphlet that said ‘no evidence of any long-term effects,’ it slowed down progress — it helped create a latency environment when the evidence showed great urgency for change,” he said. “There’s a greater need for culture change on the lower levels. When coaches and people around the games don’t have all the information, simple documents and simple messages are the most important.”