Junior Seau's Death Keeps Spotlight On Brain Injuries

CAVANAUGH: Our top story on Midday Edition, today we mark a sad anniversary. On May 2, 2012, San Diego was stunned by the death of football great Junior Seau. His fatal self-inflicted gunshot to the heart at age 43 was inexplicable at first, but then speculation began that the suicide might be linked to repeated brain injuries. And eventually studies revealed his brain showed signs of chronic traumatic encephalopathy. Many organizations in San Diego and especially in Oceanside are still coming to terms with the death of this superstar. And the medical and legal professions are involved in writing a final chapter to this story, that is, what we can learn from Seau's public tragedy. John Fiske is President of the San Diego Brain Injury Foundation. Welcome to the program. FISKE: Thank you for having me here. CAVANAUGH: And Dr. Alexander Khalessi joins us, Co-Director of Neurovascular Surgery at UC San Diego. Welcome to the show. KHALESSI: Maureen, thank you for having me. CAVANAUGH: You are actually at a convention in New Orleans. So if we hear any of that loudspeaker stuff, we'll know what's going on. Thank you for joining us. KHALESSI: Thank you. CAVANAUGH: Let me go to you first, Dr. Khalessi, the death of Junior Seau put a spotlight on the subject of brain injuries in professional sports. Do you think they're being examined more closely today than they were a year ago? KHALESSI: No question, anytime when you have the tragic loss of a public figure like Junior Seau, there's a renewed public interest on brain injury. But long before we lost Junior, there were brilliant and hardworking people at UC San Diego working every day to tackle this kind of problem. This has given us a unique opportunity to study a broad range of neurodegenerative diseases beyond those just inflicted by head injury. CAVANAUGH: What has the death of Junior Seau done to the way people are, professional sports is looking at brain injuries? FISKE: Well, he was a high-profile player. And I might say all of these players who have brought lawsuits, about 4,200 of them all across the country, it's brought to light in the mainstream media and in the mainstream culture a problem with concussive and subconcussive head injuries that are incurred over a long period of time, and in some cases, even a short period of time. A lot of this is medical research that has been around in the medical community -- peer-reviewed studies and medical studies of the brain posthumously. So now these high-profile deaths and lawsuits have really held organizations like the envelope -- their feet to the fire to get them to change their rules. CAVANAUGH: Let's establish some medical facts so we all know what we're talking about. Dr. Khalessi, the National Institute of Health discovered Seau did suffer from CTE. Remind us what chronic traumatic encephalopathy is. KHALESSI: Of course. CTE is a specific disease process that makes an anatomic diagnose on what's otherwise a chronic syndrome. It's really in four stages. It began with emotional disturbances and depression, then progressed to cognitive changes and the loss of memory, attention, executive function. And then in the end-stages, progressed to full-blown dementia. CTE remains an autopsy diagnose, that is at the time the patient ultimately passes away, in looking at sections of the brain under the microscope, we've discovered in certain brains -- areas of the brain there are abnormal collections of take tangled protein, very similar to what we see in Alzheimer's. CTE is the first condition we know across neurosciences where an environmental factor, repeated blows to the head, can prompt the progressive neurodegenerative changes in the brain. CAVANAUGH: Are we at a stage that we can know why repeated injuries to the brain cause this buildup of certain proteins in the brain? KHALESSI: Well, are it's a fantastic question. I think what we have found is that our research since Junior's death is really divided into three phases. And one thing, on the public side, we've seen it's critically important in real-time to diagnose those concussive injuries that John mentioned. During that window, there is a period of increased vulnerability to the brain. And it's the second hit that often is what promotes the maladaptive response as the neurons try to repair themselves from the trauma. And the failure repair is what leads to further cell loss. CAVANAUGH: Doctors have not been able to diagnose this condition after a person dies. Have there been any advances or research into trying to find markers for CTE so people have -- who have it category diagnosed? KHALESSI: It's a terrific question. The first important step is improving our tools. And there has been tremendous positive work at the youth sports are level and at the professional level in terms of screening for a concussion more aggressively. Once you've identified is that patient who actually has clinical symptoms that may be the result of a head injury, we're now working on more sophisticated imaging tools to then screen for the markers weave looking for. Is there is some research that has been done using pet scanning, there was one study out of UCLA and it actually found in five professional athletes an increased level of the protein in these individuals. So we are making progress in taking what was once an autopsy diagnosis and using more sophisticated imaging to diagnose these things in a way that we can intervene for living patients. CAVANAUGH: John, you've been working so closely with this advancing lawsuit. Do you know what doctors are now advising athletes to do in order to minimize the risk of major brain injuries? FISKE: One of the major developments, part of the lawsuit against the NFL, successive concussions close together in time are found to have a compound impact on the person's neurodegenerative process. So if this is a concussion for a player either at the youth or professional level, doctors are stressing certainly now that these lawsuits have been filed against the NFL new protocol that would require the NFL player or a youth player to undergo certain tests, pass those tests in order to go back into the sports arena. One of the difficulties from a brain injury perspective is that, for example, the player at the University of Pennsylvania who was found posthumously to have a CTE diagnosis at the college level, and I don't believe he had a concussive diagnosis. So even without a concussion, these impacts to the head are very dangerous. And this is very something a lot of the lawsuits allege, it's been information that has been out there for a long time but was essentially hidden by the NFL. CAVANAUGH: Let me ask you, doctor, is there anything besides staying out of the game for a while and having an assessment that doctors are advising athletes to do? Any kind of head gear, any new rules or regulations for these games? KHALESSI: Yeah, it's a terrific question. I would characterize John's comment slightly differently in the sense that the University of Pennsylvania player, for example, who had a CTE diagnosis never had a recorded diagnosis of concussion. But clearly I think from a medical standpoint, a concussion had taken place. I think the NFL has taken a lot of very positive steps in terms of setting up independent neurologic consultants to do precisely those kind of assessments in real-time. And it's so important after a head trauma takes place that the patient or the player often loses insight into their own limitations. Because the organ that's responsible for cuing them that something is wrong is often the organ that's affected. So it's critical that there are personnel who are train to the do that assessment. When we look at what is causing that trauma in the first place, it's partly an issue of equipment, and there have been a lot of mechanical studies that have been done to improve head gear. But what is more important is improvement in technique at the youth and high school level. They've done a tremendous job in developing tactics to make sure our union people are safe when they're learning the fundamentals of the game. At the NFL level, there have been specific rule changes in terms of moving off the kickoff line, and they saw a 45% in on-field concussion after those rules took place. CAVANAUGH: In the events that have happened since the death of Seau, the number of people suing the NFL over brain injury has increased. Seau's family has consolidated their lawsuit with the some 4,000 former players suing the league. John, what are the general allegations against the NFL? FISKE: Quite simply, and I say is that -- and I really everyone want to take that to heart, because the allegations against the NFL are lengthy and quite intricate. But quite simply, the allegations against the NFL specifically are that the NFL was negligent in its duty to protect the safety of the players, and that the NFL actively concealed information in a sort of a fraud allegation. And in this fraud allegation, the MTBI subcommittee or committee of the NFL was specifically called out. CAVANAUGH: What is that? FISKE: Stands for the mild traumatic brain injury committee. And this was formed in 1994 by the NFL. And in fact, the lawsuits go back to a history early in the 20th century that the NFL has held itself out to be a vanguard of player safety. And based on its assumed duty and its own assumption of this responsibility, they base their rules on this responsibility of player safety. So what has happened in these lawsuits, we've basically identified all of the studies since 1994 produced by the MTBI or even not produced by the MTBI that have disseminated information that is not correct and not consistent with the medical community. CAVANAUGH: Some might say if we're still learning about how these brain injuries are caused and how they progress, how could the NFL are know that the players were at such risk 10, 20 years ago? FISKE: There are in fact studies and review papers that have been published since the 50s that have identified subconcussive and concussive injuries over a long period of time in both football players and doctors. A lot of these papers are produced at the university level. And this was information that was contradicted by the NFL, that's what the lawsuits allege, and that different information of studies that the NFL took on and assumed the role of taking on were less than informative of the actual effects of brain injury. CAVANAUGH: How is the NFL responding to these lawsuits? FISKE: Well, procedurally right now, a lot of the lawsuits are, if not all of them, have been consolidated in what's called a multidistrict litigation, which is different than a class action. But it's a multidistrict litigation that comprises some 4,200 players in the eastern district of Pennsylvania. And currently the NFL has reacted with some procedural legal arguments in order to basically dismiss the lawsuits. Several of the lawsuits have been filed all over every single state and end up getting consolidated or transferred over coordinated, if you will, in the eastern district of Pennsylvania. Right now, the district judge, honorable Judge Brodie is reviewing arguments that were made around April9th with regard to whether or not the lawsuits should be considered under the collective bargaining agreement, and if they are considered under that, they may be preempted outside of the jurisdiction of the Courts. CAVANAUGH: Oh, I see. So what does that mean? It may not procedure as a lawsuit? FISKE: Essentially that's a motion to dismiss, and the NFL wants the judge to dismiss these motions under a federal labor management relations act code section that says that because there is a collective bargaining agreement in place, that preempts the state lawsuits that have been filed. Of course the NFL players disagree with that and say that the negligence causes of action and the fraud causes of action brought against the NFL are not covered by the collective bargaining agreement. CAVANAUGH: I want to thank both of my guests for bringing us up-to-date on the things that have gone underway in the wake of the terrible news that Junior Seau had taken his own life. Thank you both very much. FISKE: Thank you. KHALESSI: Maureen, thank you for your time.