Medicines for Chronic traumatic encephalopathy

What it is

Chronic traumatic encephalopathy (CTE) is a progressive brain condition that is thought to be associated with repeated head injuries or repeated blows to the head over a period of time. It has received particular attention in relation to contact and collision sports (such as boxing, and certain forms of football, rugby, and other sports) and other situations involving repeated head impacts, where a history of repeated concussions or head knocks over years may be linked to developing the condition later in life. CTE is thought to involve a build-up of an abnormal protein in the brain, which is associated with progressive damage. An important point about the current understanding of CTE is that it is an area of ongoing research, and much is still being learned — including exactly how it develops, who is at risk, and how it relates to head injuries; and, at present, CTE can only be definitively diagnosed by examining the brain after death, so during life it can be suspected based on the person’s history and symptoms, but not confirmed with certainty. The symptoms that have been associated with CTE typically develop years after the period of head injuries, and can include: problems with memory and thinking (cognitive difficulties, which can progress); changes in mood and behaviour — such as depression, irritability, aggression, impulsivity, and other changes; and, over time, features that can overlap with other progressive brain conditions, including problems with movement in some cases. However, these symptoms are not specific to CTE and can be caused by many other conditions (some of which are treatable), so it is important that anyone with such symptoms is properly assessed. Because CTE is thought to be linked to repeated head injuries, and because there is currently no cure, prevention is a very important theme — reducing repeated head impacts, managing concussions properly (including appropriate rest and graded return after a head injury, and not returning to activity too soon), and measures in sports and other settings to reduce head injuries. For a person with symptoms that may be related, care focuses on assessing and managing the symptoms (such as treating depression, and supporting cognitive and other difficulties) and supporting the person and family. The key messages are that CTE is a progressive brain condition thought to be linked to repeated head injuries over time, that prevention through reducing head impacts and managing concussions properly is key, and that care focuses on assessing and managing symptoms and supporting the person and family.

How it is treated

The approach to chronic traumatic encephalopathy centres on prevention (reducing repeated head impacts and managing concussions properly), and, for those with symptoms that may be related, careful assessment and management of the symptoms and support; there is no cure, and understanding of CTE is still developing. Prevention is a key and practical theme, given that CTE is thought to be associated with repeated head injuries and that there is currently no cure: this includes reducing repeated head impacts and injuries where possible — for example, measures in contact and collision sports and other relevant settings to reduce head injuries (such as rules, technique, and equipment), and reducing exposure to repeated head impacts; and, very importantly, managing head injuries and concussions properly — including recognising concussion, appropriate rest and recovery, a careful, graded return to activity (particularly sport), and not returning to activity or sport too soon or while still symptomatic, as a further head injury before recovery can be harmful; there is growing awareness and guidance about concussion management in sport and other areas. For a person who has symptoms that might be related to CTE (such as progressive memory, thinking, mood, or behavioural changes, particularly with a history of repeated head injuries), an important step is proper assessment — because these symptoms are not specific to CTE and can be caused by many other conditions, some of which are treatable, it is important to see a doctor for assessment to identify the cause and any treatable conditions, rather than assuming the symptoms are due to CTE (which, at present, cannot be confirmed during life). Assessment may involve a specialist (such as a neurologist), and tests to look for causes and exclude treatable conditions. Management then focuses on assessing and managing the symptoms and supporting the person: this can include treating any conditions found; managing specific symptoms — such as treating depression and other mood or behavioural symptoms (which is important, as these can be helped and supported), and supporting any cognitive or other difficulties; and providing support for the person and family, including practical, emotional, and, where relevant, specialist support, as with other progressive conditions. Because CTE is an area of ongoing research, understanding and approaches continue to develop. Support for mental health is particularly important, given the mood and behavioural symptoms that can be associated, and it is important to seek help for depression or any thoughts of self-harm. The reassuring and important messages are that prevention — reducing repeated head impacts and managing concussions properly — is a key theme in relation to CTE, that anyone with possible symptoms should be properly assessed (as the symptoms are not specific and may have treatable causes), and that care focuses on assessing and managing the symptoms (including treating depression and supporting difficulties) and supporting the person and family; so prevention, proper assessment, symptom management, and support are the key aspects, in a field where understanding is still developing.