Chronic Traumatic Encephalopathy CTE Clinical Pathophysiologic and Therapeutic

Chronic Traumatic Encephalopathy (CTE): Clinical, Pathophysiologic and Therapeutic Aspects Patricio F. Reyes, MD, FAAN Program Director Health. Partners Medical Group St. Paul, MN

Affiliations Yuma Pharmaceuticals Chief Medical Officer Chair, Scientific Advisory Board Retired Players Association (NFL) Chief Medical Officer Board Member Association of Ringside Physicians Board Member

Junior Seau Junior Seau in 2008 with the New England Patriots No. 55 Linebacker Personal information Date of birth: (1969 01 19)January 19, 1969 Place of birth: San Diego, California Date of death: May 2, 2012(2012 05 02) (aged 43) Place of death: Oceanside, California Height: 6 ft 3 in (1. 91 m) Weight: 248 lb (112 kg) Tiaina Baul "Junior" Seau Jr. ( ; January 19, 1969 – May 2, 2012) was a linebacker in the National Football League (NFL) who became a San Diego sports ic Career information Of Samoan descent, Seau played college football at the University of High school: Oceanside (CA) Southern California He was taken by the San Diego Chargers as the fifth overall p. Seau retired from pro football in 2010. A standout College: Southern California NFL Draft: 1990 / Round: 1 / Pick: 5 Debuted in 1990 for the San Diego Chargers Last played in 2009 for the New England Patriots Career history • San Diego Chargers (1990– 2002) • Miami Dolphins (2003– 2005) • New England Patriots (2006– 2009) Career highlights and awards • 12× Pro Bowl (1991, 1992, 1993, 1994, 1995, 1996, 1997, 1998, 1999, 2000, 2001, 2002) • 8× First team All Pro (1991, 1992, 1993, 1994, 1995, 1996, 1998, 2000) • 2× Second team All Pro (1997, 1999) • 2× AFC Champion (1994, 2007) • NFL Alumni Linebacker of the Year (2003) • AFC Player of the Year (1994) • Walter Payton Man of the Year (1994) • UPI AFC Defensive Player of the Year (1992) • NEA NFL Defensive Player of the Year (1992) • NFL 1990 s All Decade Team • San Diego Chargers #55 retired • San Diego Chargers Hall of Fame • San Diego Chargers 50 th Anniversary Team Career NFL statistics as of 2009 Tackles 1, 849 Sacks 56. 5 Interceptions 18 Forced fumbles 3 Pass deflections 21 Stats at NFL. com

What is Dementia Pugilistica (DP)? • • “boxer’s syndrome, ” “punch drunk syndrome, ” “chronic boxer encephalopathy, ” “traumatic boxers encephalopathy. ” Can mimic Alzheimer’s disease Can mimic Parkinson’s disease Chronic Traumatic Encephalopathy

• Encephalopathy Save Email Print Share • Dementia with Lewy bodies • Brain damage • Amnesia MLA given Progressive Brain Damage: Tom Mc. Hale Of NFL Suffered From Chronic Traumatic Ence In addition, the CSTE has discovered early evidence of CTE in the youngest case to date, a recently deceased 18 year old boy who suffered multiple concussions in high school football. Football And Mc. Hale, a Cornell University graduate, former restaurateur, husband father of three boys, is the sixth former NFL player to be diagnosed post mortem with CTE since 2002. CTE, a progressive ne Science. Daily (Jan. 27, 2009) — Leading medical experts at the Center for the Study of Traumatic Encephalopathy (CSTE) at Boston University School of Medicine (BUSM) reported toda Boston University (2009, January 27). Football And Progressive Brain Damage: Tom Mc. Hale Of NFL The other former NFL players diagnosed with CTE are former Pittsburgh Steelers Mike Webster, Terry Long and Justin Strzelczyk, along with Andre Waters and John Grimsley. Waters and Long comm Note: Source: According to Ann Mc. Kee, MD, CSTE co director and a leading neuropathologist who specializes in degenerative brain diseases, "CTE has been described for approximately 80 years. Initially referred t Story If no author is, the source is cited instead. Disclaimer: This article is not intended to provide medical advice, Universityor treatment. Views expressed here do not necessarily reflect those of Science. Daily or its staff. Due to the growing strength of these findings linking brain trauma on the football field to CTE, a number of living former NFL players have recently agreed to join three time Super Bowl champion Te The above story is reprinted from materials provided by Boston diagnosis. enlarge The 88 Plan was named after former NFL star John Mackey's jersey number. Mackey, a Hall of Fame tight end for the Colts in the 1960 s and 70 s, suffers from severe dementia. The plan was created b Note: Materials may be edited for content and length. For further information, please contact the source cited above. Following death, CSTE doctors will be able verify with certainty whether or not 88 Plan members' dementia was caused by trauma sustained in sports like football (i. e. , CTE) or by other causes of dem CSTE is a collaboration between SLI and BUSM. SLI was founded by former Harvard football player and WWE pro wrestler Chris Nowinski, and neurosurgeon and concussion expert Robert Cantu, MD Co Director of the CSTE, Stern, said, "CTE is the only fully preventable cause of dementia. By studying large numbers of athletes throughout their lives, as well as examining brain tissue through our e The discovery of the initial stages of CTE in an 18 year old should move the discussion of football's concussion crisis toward youth football. The identity of the 18 year old will not be revealed at the f Lisa Mc. Hale, widow of Tom Mc. Hale, said, "What's even more disturbing to me, and the reason I am here, is that Tom is not alone. His is now the sixth confirmed case of CTE among former profession NFL players who have recently chosen to join the CSTE brain donation registry include Hall of Famers Joe De. Lamielleure and Willie Wood, an 88 Plan member. They are joined by Ken Gray, Brent Boy Share this story on Facebook, Twitter, and Google: Other social bookmarking and sharing tools: Share on blogger. Share on digg. Share on fark. Share on linkedin. Share on myspace. Share on newsvine. Share on reddit. Share on stumbleupon| 121 How dangerous is football? Lisa Mc. Hale, widow of Tom Mc. Hale, said, "What's even more disturbing to me, and the reason I am here, is that Tom is not alone. His is now the sixth confirmed case of CTE among former profess

Signs and Symptoms of Dementia Pugilistica • • Declining mental ability Tremors Rigidity Bradykinesia Lack of coordination Evolution is insidious Language difficulties

Contusion Reyes ‘ 07

Diffuse Axonal Injury

Dementia Pugilistica and Parkinson’s Disease • Pallor of substantia nigra (SN) • neuronal loss in SN • Lewy bodies – Tremors – Rigidity Pale SN – Bradykinesia – Postural instability Lewy Bodies Pale Normal

Similarities Between Dementia Pugilistica and Alzheimer’s Disease • • Progressive dementia Large numbers of NFTs and NPs Acetylcholine deficiency Lesions are usually concentrated in the hippocampus and other parts of the limbic system which are important in memory related processes, emotional expression and behavior

Chronic Traumatic Encephalopathy (CTE) • Latent complication of traumatic brain injury • Neurodegenerative Disorder • Affects young adults and middle aged • Contact sports • Subconcussive and concussive injury • Cognitive and behavioral symptoms • ? Pathophysiology • No treatment

Neuropathology of CTE • Lagre numbers of NFT • NFT distribution distinct from AD • May have neuritic plaques

Neuronal Morphology and Physiology • Influenced by cytoskeletal proteins • Skeletal scaffolding • Microtubules main cytoskeletal component • Normal neuronal morphology and physiology require stable microtubules

Military Servicemen/Women • Non penetrating injuries • Symptoms similar to CTE • High incidence of ALS • High incidence of PTSD • Several thousands affected • Young members of the military

Hypotheses • Single/Repeated axonal damage • Biochemical, structural, membrane, and metabolic perturbations • Hyperphosphorylation of tau • Increase NFTs

Traumatic Brain Injury (TBI) • Shearing, deformation, elongation and stretching of axons • Alters membrane permeability • Ionic shifts • Caspase and caspain release – Tau phosphorylation, protein misfolding, – truncation, aggregation, cytoskeletal dissolution – * CCI Txg ↑ tau after 24 hrs – 7 days –