Chronic traumatic encephalopathy: symptoms, causes and treatment.

Summary of the characteristics of Chronic Traumatic Encephalopathy, a neurodegenerative disease.

There is no doubt that sport has a lot of benefits, both physical and mental. However, a little known aspect, especially of contact sports, is the damage that can be caused at brain level.

These injuries would be due to, for example, punches in boxing or tackles in American soccer, generating damage at the neuronal level that causes cognitive impairment, emotional instability and motor problems.

Chronic Traumatic Encephalopathy is a neurodegenerative disease associated with impacts to the brain.. It has been linked to both athletes and victims of some type of head injury. Let's take a closer look at what it involves.

What is Chronic Traumatic Encephalopathy?

Chronic Traumatic Encephalopathy, formerly called dementia pugilistica or "punch drunk syndrome", is a neurodegenerative disease, mainly caused by a neurodegenerative disease, mainly caused by repeated head injuries.. This syndrome has been linked to many contact sports, such as boxing, football, field hockey and martial arts, although it has also been seen in victims of domestic violence and survivors of explosions, such as military personnel.

It affects the brain, causing various cognitive, psychomotor and mood symptoms. Despite the severity of its symptoms, which involve planning problems, memory lapses, slowness of movement and sudden mood swings, these do not begin to appear until several years after the injuries were sustained, this being its main problem.

Chronic Traumatic Encephalopathy cannot be diagnosed during lifeexcept for rare cases in individuals with high-risk exposures. This neurological disease is still being studied and its exact frequency in the population is not known, and the causes may be multiple. There is no known cure for chronic traumatic encephalopathy.

Symptomatology

Although several symptoms have been related to chronic traumatic encephalopathy, the fact that it can only be diagnosed post-mortem means that it is not really clear what all the symptoms are.

It has also been seen that people who have worked in professions who have exercised professions in which the repeated blows to the head were present have, after a few years, manifested manifest, after a few years, the following problems.

• Cognitive impairment: problems in thinking.
• Impulsive behavior and substance abuse.
• Emotional instability: depression, anger, mood swings.
• Aggressiveness, both physical and verbal.
• Short-term memory loss, especially related to daily tasks.
• Difficulties in executive functions: problems in planning.
• Emotional instability.
• Suicidal thoughts and behaviors.
• Generalized apathy: lack of expressiveness and emotional interest.
• Motor problems: starts out clumsy and progresses to slowness, stiffness and coordination problems.

There seems to be a relationship between the severity of this brain disease and the time spent in contact sports, along with the amount of blows received.The number of blows received to the head or the number of traumatic injuries. It should also be noted that it may be the case of receiving only a single traumatic injury and that this is so strong that, after a few years, the disease appears, being the case of survivors of explosions.

The clinical deterioration of this disease is gradualThe clinical deterioration of this disease is gradual, appearing after a few years since the lesions occurred, or even after several decades. This deterioration occurs in three phases:

1. Early phase

The first symptoms of cognitive impairment begin to appear as a consequence of the strokes. Although no clear onset has been established, the disease is usually latent in the early years.

It is in this early phase that affective affective disorders and psychotic symptoms begin to appear..

2. Advanced phase

This phase occurs between the ages of 12 and 16 years after the contact sport or traumatic injury began, although it may vary from person to person.

Social instability, erratic behavior, loss of memory, and symptoms related to contact sports. and symptomatology related to the early stages of Parkinson's disease. The symptoms are already becoming clearer, although it cannot yet be classified as dementia.

3. Dementia stage

Symptomatology is more severe, being well established and affecting the subject's functionality in all areas of his life. Mental faculties such as memory and reasoning are lost, in addition to speech and gait abnormalities.

Diagnosis

At present there is no definitive clinical diagnosis for Chronic Traumatic Encephalopathy, due to the lack of specificity in the symptoms attributed to this neurological disease. However, the study of brain tissues once the patient has died allows to confirm if the individual had the disease..

In any case, attempts have been made to use neuroimaging techniques to see if it is possible to make a safe diagnosis while the patient is still alive.

The possibility of using Positive Emission Tomography with Fluorine 18 to detect the pathology in the living brain has been under development. Since the disease is not the disease is not associated with a particular lesion in the brain, it is not it is not possible to diagnose it by simply looking at images of the brain without understanding how damaged the brain tissue is.

What happens to the brain in this disease?

When a stroke is received, the white matter of our brain suffers the most. This matter is a part of the central nervous system composed of myelinated nerve fibers, which acts as a transmitter and coordinator of communication between different nerve regions.

The brain has a constitution similar to that of jelly.This means that in the event of an impact, a lot of pressure is put on its nerve fibers, which can break and cause damage both in the short and long term.

Although the skull is a great protector of the brain and the cerebrospinal fluid is the substance that cushions the impacts, if the blow is very strong, the brain bounces against the cranial walls, causing damage. This can cause loss of consciousness, hematomas, hemorrhages and sudden death.

The damage behind this disease is not a particular injury in a particular area of the brain, but a progressive damage in the brain tissue. The brain loses some of its weight, associated with atrophy of the cerebral lobesThe brain loses some of its weight, associated with atrophy of the cerebral lobes: the frontal lobe (36%), the temporal lobe (31%), the parietal lobe (22%) and, to a much lesser extent, the occipital lobe (3%). In addition, the lateral ventricle and the third ventricle are dilated. The fourth ventricle is rarely dilated.

The corpus callosum thins and the cavum septum pellucidum shows fenestrations. The cerebral tonsils are losing neurons, the substantia nigra and the locus coeruleus are damaged. The olfactory bulbs, thalamus, mammillary bodies, brainstem and cerebellum atrophy and, as the disease becomes more severe, the hippocampus, entorhinal cortex and amygdala are also damaged.

Similar to Alzheimer's disease, in Chronic Traumatic Encephalopathy a large number of neurofibrillary tangles of Tau protein are present.. Neuropil threads and glial tangles can also be found.

Risk factors

The main risk factor is the practice of contact sports, together with being a victim of domestic violence, having lived through an explosion or being part of military personnel.

Deterioration is the result of various head injuries, very common in sports such as boxing, kick-boxing, motorized racing sports and martial arts.. Other risk factors include playing a contact sport at a young age, not using proper protection and not using injury prevention strategies.

Protective factors

The main protective factor is the most obvious: protecting the skull when playing contact sports, especially those in which repetitive blows to the head are unavoidable, such as boxing or kick-boxing. This is why the use of helmets is so important, in addition to reducing the number of bouts or matches per season and make sure that the contestants do not hurt themselves more than necessary.

It is very important to see a doctor, whether or not you have cognitive, emotional and psychomotor symptoms associated with the disease. Although they have not yet presented, it is possible to perform tests that evaluate cognitive impairment, emotional stability and psychomotor skills that allow objective evidence that the first phase of the disease may be occurring. Medical follow-up in persons at risk can prevent further damage through early intervention techniques.

Treatment

There is no cure for Chronic Traumatic Encephalopathy. The main intervention measure consists of avoiding risk factors.. In the case of contact sports, the patient should try to avoid any risk, using the appropriate protective measures.

If symptoms of the disease are already showing, there are two general ways to treat it. The first is medicalization, using drugs that act on specific symptoms, while the second is rehabilitation, which, as in dementias such as Alzheimer's and Parkinson's, should be as early as possible, taking advantage of brain plasticity to make the most severe symptoms of the disease occur later.

Bibliographic references:

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