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Q&A: Concussion Legacy Foundation’s Dr Sam Bureau

This February 2024 was CTE awareness month. Medical News Bulletin was fortunate to have the opportunity to quiz Dr Sam Bureau, Senior Director, International Research at the Concussion Legacy Foundation.

You might remember hearing about Chronic Traumatic Encephalopathy (CTE) in the news, or maybe you saw the acclaimed sports film Concussion at the movie theatre? Repetitive concussions might be something you associate with pro-athletes or high drama on the big screen but the reality is that repeated head injuries are closer to home than you think.

We asked Dr Sam Bureau, of the Concussion Legacy Foundation to tell us a little more about what CTE is and how we can keep ourselves and our kids safe during sports.

What is CTE? 

CTE is a progressive neurodegenerative disease caused in part by repeated traumatic brain injuries, which include concussions and nonconcussive impacts. CTE cannot be diagnosed definitively during life yet, but this is a major research priority for experts in the field. CTE neuropathology is characterized by misfolded tau protein found in specific patterns in the brain unique to CTE. This is how we are able to distinguish CTE from other diseases that also involve tau pathology.

Who is most at risk?

Individuals with a history of repeated traumatic brain injuries (both concussions and nonconcussive impacts) are at most risk of developing CTE. This does not mean a handful of concussions. Often times, those diagnosed with CTE experienced thousands if not tens of thousands of impacts over the course of their career/life. Contact and collision sport athletes, those with military service, and others with exposure to repeated traumatic brain injuries are among populations most at risk.

How can we prevent it?

The good news is that CTE is an entirely preventable neurodegenerative disease, the only disease for which this is true. This is because CTE is caused by an environmental exposure, repeated brain trauma. With this in mind, the best way to prevent CTE is to drastically reduce exposure to repeated brain trauma. In a sports context, this means drastically reducing, if not eliminating, contact in practice, and modifying rules to the game to limit total exposure. We strongly recommend youth under the age of 14 have no exposure to unnecessary repetitive head impacts. To accomplish this, we recommend removing tackling, heading, and checking from contact and collision sports such as football and rugby, soccer, and hockey and lacrosse, respectively, until the age of 14. 

Are there diagnostic tests in development?

Several research groups are in the process of exploring potential diagnostic tests for CTE to aid with an in-life clinical diagnosis. Research on biomarkers, such as imaging biomarkers and blood biomarkers, continues to progress. 

What are the research priorities right now?

Current research priorities revolve around identifying and validating a clinical diagnostic criteria and objective measurements so that an in-life diagnosis can be made. From here, research can progress to explore treatments and disease modifying therapeutics.

Are there age/developmental effects? for example is it worse for TBIs or repeated concussions starting in adolescents or is there more impact for older people?

The current body of literature has not clearly explored this question. However, over and over again the research demonstrates that risk of developing CTE increases the longer a career as more impacts are sustained. The reason we advocate for reducing contact at the youth level is because very few athletes play beyond the high school level and even fewer athletes play beyond the collegiate level. A child that begins playing tackle football at 5 years old and plays through high school is at 10 times greater odds of developing CTE than a child that begins playing at 14 and also plays through high school.

Do traumatic brain injuries or repeated concussions contribute to other brain disorders?

Brain injury is a risk factor for several brain disorders and diseases. Brain injuries have been associated with the development of new and/or worsening existing mental health conditions and increased risk for neurodegenerative diseases such as Alzheimer’s, Parkinson’s, and ALS, among others. 

What would you say to school sports coaches and parents ?

I would strongly recommend coaches and parents evaluate if exposing young athletes to a potential life altering neurodegenerative disease is necessary. As a former contact sport athlete that played in the NCAA, I understand the passion behind sport, particularly at a young age. Sport gave me some of my best memories as a child; however, those memories would have still been made even if I had not been exposed to repetitive head impacts as a child through sport. Whether I headed the ball, got checked in hockey, or made a tackle did not have any bearing on the lessons I learned as an athlete. The values learned from sport, such as teamwork, discipline, and perseverance, were independent of the contact associated with the sports I played. Emerging evidence suggests that exposure to repeated brain trauma can negatively impact performance by decreasing reaction time. So, all health arguments aside, if you want your child to have the best shot at performing at the highest level, it is in their best interests to minimize exposure to repeat head impacts.

Are there any developments that you are excited about right now?

I am excited to see the rapid progress we are seeing globally within the field. Researchers in Australia, the UK, Canada, New Zealand, Brazil, and others, are contributing to the body of research at a rapid pace, showing us that CTE is not only an American problem. In 2023 we saw the first two female athletes diagnosed with CTE published and the first public case of CTE linked to domestic violence. The increased awareness of CTE and CTE in women in particular much needed so that we can continue to drive research efforts around the world so we can one day diagnose and find a cure.

If you had one thing you’d like to tell our readers, what would it be?

It is possible to love sports and also want to see them played in a safer way. CTE is a devastating neurodegenerative disease that is entirely preventable. That means it is in our hands to drastically reduce the number of cases we are seeing and the only way we can do that is if we come together. At the end of the day, we have to weigh the risks of doing nothing vs. the risks of doing something. If we are right, and CTE is caused by repeated traumatic brain injuries, reforms to make sports safer and reduce exposure to cumulative head impacts will prevent future cases of CTE. If we are wrong, and CTE is caused by something else, children will still have played sports, just without head impacts, and we will certainly reduce the number of concussions received in youth sports. To me, the risks of doing nothing far outweigh the risks of doing nothing. 

Joanna Mulvaney PhD
Joanna Mulvaney PhD
Joanna Mulvaney worked as a bench researcher for much of her career before transitioning to science communication. She completed a PhD in developmental biology focusing on cell signaling in cardiogenesis at the University of East Anglia, Norwich, UK, before moving on to study axial skeleton development and skeletal myogenesis at King’s College London and regeneration of auditory cells in the ear at University of California San Diego Medical School, USA and Sunnybrook Research Institute, Toronto, Canada. When it comes to scientific information, her philosophy is: make it simple, make it clear, make it useful.
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