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Brain Injury Revisited

Image by Graham Perry

This summer, one of the National Football League’s most honored linebackers, Junior Seau, was inducted into the league’s Hall of Fame -- posthumously. The Dallas Morning News described him as “probably the most dynamic player of his era.” But only Seau’s family attended the induction: the retired player had killed himself in 2012. Nine months later, the National Institutes of Health reported that he had a degenerative brain disease consistent with chronic traumatic encephalopathy (CTE), making him the most prominent player to be associated with the disease. That same month, Seau’s family sued the NFL, alleging that his suicide was caused by a brain disease developed from years of sustaining hits while playing in the league. The induction brought renewed attention to the disease.

Scientists and clinicians -- including some faculty members and alumni of the Perelman School -- have been expanding our knowledge of CTE and other brain injuries and coming up with ways to detect and treat the injuries sooner. The Fall 2014 issue of Penn Medicine featured “The Brain in Peril,” a suite of articles about the harm that sports and warfare can do to the brain, including one about the growing recognition of the danger of CTE. Unlike traumatic brain injury, which can result from one or two very hard hits to the head, CTE seems to emerge after countless smaller shocks. As H. Branch Coslett, MD 1977, a professor of Neurology, pointed out, it is not yet clear why some people who have received blows to the head get CTE while others do not. It’s a longstanding mystery. The first positive diagnosis of CTE in a football player was published in 2005, by Bennet Omalu, MD, then at the Allegheny County coroner’s office.

Last month, more results about CTE were released. Researchers with the Department of Veterans Affairs and Boston University reported that 11 of the 12 brains of deceased former NFL players tested over the past year showed signs of the disease. So far, the brains of 87 out of 91 former NFL players have tested positive for the disease. In all, the researchers have now found CTE in the brain tissue in 131 out of 165 individuals who, before their deaths, played football either professionally, semi-professionally, in college, or in high school.

But the NFL, whose annual revenues are now about $10 billion, has been very slow to deal with CTE or concussions. In fact, when Omalu published his first article on his discovery in the journal Neurosurgery, the league demanded that it be retracted. For many years, its own doctors continually dismissed his findings as seriously flawed and purely speculative.

Now, however, there are rumors that the NFL has again stirred itself in response to a movie set to open on December 25: Concussion, starring Philadelphia’s own Will Smith as Dr. Omalu. Last month, The New York Times reported that the movie had been altered to avoid antagonizing the NFL. The director of the new film, Peter Landesman, disputed the report. “We always intended to make an entertaining, hard-hitting film about Dr. Omalu’s David-and-Goliath story,” said Landesman. “Anyone who sees the movie will know that it never once compromises the integrity and the power of the real story.” The viewers, of course, will judge.

Philadelphia’s Fox29 also took notice of Concussion’s trailers last month. It ran a segment featuring M. Sean Grady, MD, chair of Penn Neurosurgery, and Garry Cobb, a former NFL player (for a time with the Eagles) and now a Philadelphia TV and radio personality. As Grady put it, only a small percentage of players do have brain problems after their careers, “but we still don’t know why that is.”

Last fall, Penn Medicine noted that much of the work in this field has been conducted through Penn’s Center for Brain Injury and Repair, directed by Douglas Smith, MD, a professor of Neurosurgery. One of the articles described the work of Kacy Cullen, PhD, a research professor of Neurosurgery. He and other Penn researchers are broadening the scope of investigation into the impacts of significant head trauma, by pinpointing exactly what happens to the brain when it’s exposed to an explosive shock. Such blasts are now responsible for two-thirds of the injuries suffered by soldiers in Iraq and Afghanistan.

Brain injuries, however, are often difficult to diagnose. To detect the impact of the blast, Cullen collaborated with Smith and Shu Yang, PhD, a professor of materials science and engineering in Penn’s School of Engineering and Applied Science, to create a “blast badge.” Composed of photonic nanocrystals sculpted by laser to form an intricate molecular pattern, the badge when damaged by a blast shock wave changes color. The color varies depending on the severity of the blast.

This summer, Yang and her team presented their related research at the 250th National Meeting & Exposition of the American Chemical Society, held in Boston. They have developed a polymer-based material that also changes colors depending on how hard it is hit, but is easier to produce than the earlier crystals. The change of color in the polymer version is permanent, making it better suited to record the strength of the impact. Now, however, the focus is beyond bomb blasts. The newer version could eventually be used in consumer products like football helmets. According to Yang, “If the force was large enough and you could see that as easy as reading a litmus test, then you could immediately seek medical attention.” The decisions could, finally, be taken out of the hands of fallible coaches and trainers.

In related news, two neuroscience students in Penn’s College of Liberal and Professional Studies won the Neuro Startup Challenge of the National Institutes of Health. Both have worked in Penn Medicine’s Clinical Cell and Vaccine Production Facility. They are now marketing their entry in the challenge: a device that simulates a blast-induced traumatic brain injury and can track and compare any cellular changes.


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