Waiting on Science our Savior: How cells die from concussions

As has been insisted before on this blog, long and loud, the damage done to football players' brains -- what we call chronic traumatic encephalopathy, or CTE -- is not -- I repeat, not -- strictly a matter of repeated concussions. Concussions still matter, though, and new research that hit print a couple of weeks ago offers a fairly chilling assessment of just how concussions do their dark anti-magic on the brain.

The research appeared in the journal Scientific Reports on August 2. It contains at least two striking and somewhat worrying findings in relation to the kinds of brain blows football players and other athletes receive, findings that can be informally correlated to the experiences of some such athletes with concussions.

Finding 1, demonstrated with a nifty time-lapse video in the CNN report linked above, suggests that how the individual cells that are damaged by concussive blows might be different than one might expect. As shown in the video, the damaged cell doesn't necessarily show a lot of damage on the outside, for as much as six hours. From that point forward, though, the damage becomes clearer, and as soon as another six hours the cell is dead.

What this seems to indicate, chillingly, is that the damage doesn't show up at first because it happening within the cell, an internal chemical process that only begins to show up in external observation once the affected neuron is mostly deteriorated inside. As a result, once the damage begins to show up on the cell's exterior, it's probably too late for that cell; the damage is irreparable.

I should hope it doesn't require explanation to consider this happening to multiple cells, neuron upon neuron, in the course of one concussion, a horrifying thought. So much brain damage -- what else is there to call it? -- in one moment.

It also makes some intuitive sense when one considers how many concussions reported among NFL players weren't immediately detected or the degree to which concussion symptoms don't always show up immediately. If the deterioration of a single cell can take up to twelve hours, it "sounds right" that it might take that long (or sometimes longer?) for a victim of a concussion to feel its effects.

On the flip side of that chilling thought, comes a thought about chilling. This bit of information offers some hope for researchers, who hope to build upon previous research suggesting a kind of hypothermia -- a "brain freeze," or at least a brain cooling, if you will -- may offer hope for heading off the damage before it becomes irreversible. Those studies aren't conclusive yet, though more are on the way. The researcher presenting the current research, Christian Frank of Brown University, is working with the concept of an inhaler-type device that would deliver a shot of cold air through the blood vessels to the brain and arrest the deterioration at the cellular level.

So in the future, if your favorite quarterback or safety comes off the field looking concussed, you might just see the medical staff hitting him with what looks like an asthma inhaler, but the medic might just be applying a brain freeze.

But back to the downsides. The research also suggested more strongly than before that there might be more than one type of brain injury going on in cells when concussive blows are received. Beyond the obvious blows (leaving the signs you might have seen if you saw the movie Concussion), researchers also found a second, less obvious type of damage, in which cells essentially "pull back" their connections from the surrounding neural networks and, in essence, quit.

This isn't a kind of injury that shows up readily in any kind of examination, pre- or post-mortem. So in other words, all those horrible stories of brains that were examined by the likes of Dr. Bennet Omalu or Dr. Ann McKee, reported to be so grisly and horrible ... might just have been understated.

At the risk of overusing a word, there is something particularly chilling in seeing such neuron deterioration playing out. Then doing the math; how many cells affected by a given blow? how many such blows a game? do all the blows really have to be concussion force to affect some of this kind of damage?, and the heart sinks, or hopefully it does, if you have one.

Concussions happen outside the NFL, of course. One might see the military, in the age of roadside bombs, standing to gain greatly from such research as this and any possible treatments that derive from it. Depending on the level of your pacifism one might see such injuries among soldiers as sad but inevitable or just sad and criminal, but at minimum one would hope no one would begrudge any such affected veteran whatever hope this research might produce.

One hopefully would not begrudge such hope to football players or other athletes, either, but to concede that point should not forestall the question of whether we have any business indulging in the behavior that produces such damage. Does our need for entertainment or our thirst for cathartic violence really justify this?

Concussions happen in other sports besides football, of course. So far, though (aside from certain elements in the NHL), no other sport seems inclined to treat such damage as necessary and inevitable.  Other sports don't talk about the violence that produces these injuries as intrinsic or necessary to the game, or have fans who make asinine sexist remarks about putting skirts on the players when any mitigation of such blows is suggested.

So even as a study like this one offers some beacon of hope, it points ever more deeply to the troubling and powerfully problematic nature of the whole enterprise, one that has been going on for decades. No person should feel even the tiniest compunction against deciding that she or he can't or won't watch it happen anymore.

Watch a neuron die. Now imagine a whole bunch at one blow. 

(As seen in Scientific Reports)