Earlier this year the MMA community was shocked by the tragic loss of Jordan Parsons, the shining star of Bellator, hit and killed as a pedestrian by an alleged drunk driver. 6 months later, an autopsy revealed that he was suffering from a degenerative brain disease called chronic traumatic encephalopathy, or CTE. This diagnosis was confirmed by Dr. Bennet Omalu, the man who first discovered that disease in a former NFL player and whose life has been recently played by Will Smith in the movie Concussion.

Since then we know that CTE has been affecting former NFL athletes, ice hockey players, and WWE wrestlers. But Jordan Parsons is the first MMA fighter that has been officially diagnosed with this disease. The scary part is that Jordan was a very young athlete with (relatively) not so many fights and only one loss by KO, which lead to think that many more athletes might be suffering from CTE without knowing it. This tragedy could be a much needed turning point in the health management of the MMA fighters.

What is a CTE?

CTE is a degenerative disease of the brain that develop slowly (usually over a ten-year period), and that is caused by severe blow or repeated blows in the head. It leads to several neurological symptoms such as headaches, memory loss, change in cognitive and emotional function, poor judgment, increased irritability and suicidal thoughts just to name a few. However the final diagnosis can only be made post-mortem with a brain autopsy. This obviously makes very hard to estimate the prevalence of this disease, especially in recent sports such as MMA. CTE is characterized by atrophy (loss of volume) of the brain as well as accumulation of tau protein, which are also present in other degenerative diseases such as Parkinson’s or Alzheimer’s. There are some overlap between the symptoms of those diseases suggesting some misdiagnosis. It is thought for instance that Muhammad Ali was actually suffering from CTE and not Parkinson’s disease.

The widespread of the symptoms and the difficulty to diagnose it makes CTE hard to detect, and to this date there is no cure. For instance, it seems that Jordan Parsons was not presenting with any symptoms of brain degeneration, making the researchers believe that there are some genetic and environmental components that makes some people develop CTE earlier than others. Experts all agreed that the car accident causing Parsons’s death cannot be responsible for those degenerative changes in his brain, because it was too recent and tau protein accumulation happens over the course of several years. It is possible that Parsons had Lyme disease or another infection causing increased production of tau proteins. Nevertheless, if Parsons was actually suffering from CTE, it opens a can of worms for all MMA athletes and this is bad news.

What it implies for the MMA athletes

Let’s make the very plausible assumption that Parsons was actually suffering from CTE. If this is the case, does that mean that many more athletes will be diagnosed as well in a near future? Sadly yes, it wouldn’t be surprise if CTE was affecting a lot of MMA fighters. After all, blows in the head are so common and most of the fighters don’t have access the medical support they deserve. This should ring an alarm and create a shift in the healthcare management of MMA athletes. So far, we have been focused in musculoskeletal injuries which is of course important. However, it is now time to understand that the brain is just like any other organ of the body. It needs to be protected and rehabilitated after being injure otherwise it will lead to dramatic consequences. Several clinics across the country, following the teaching of Professor Ted Carrick (the man who treated NHL superstar Sidney Crosby’s concussion), specializes in rehabilitation post-traumatic brain injury. It is now the time for those cutting-edge clinics to become more mainstream and even collaborate with MMA organizations for the benefit of their athletes health before it’s too late.

Dr. Benett Omalu has diagnosed with CTE two pro wrestlers, Jon Rechner and Brian Knighton, who both died this year at 44 years old, leading to a lawsuit against WWE, accusing of putting their financial interest above the health of their athletes. The NFL faces similar charges after the late Mike Webster (Pittsburg Steelers) was diagnosed with CTE. A settlement of $1 billion with the players was reached. Are we going to see professional fighters suing the UFC of Bellator? Possibly, but in the meantime many things can be done to preserve the fighters’ health.

What can (should) be done

Like I said before, CTE can only be diagnosed post-mortem. However, there are early signs that suggest some level of degeneration or at least dysfunction of the brain. The story of Gary Goodridge is another sad example of what CTE might look like at a quite advanced stage. But for earlier stages, even though an athlete seems asymptomatic, a thorough neurological exam can reveal some abnormalities.

Concussion screening:

There are many tests (C3Logix, SCAT3,..) and they are easy and quick to perform. The most advanced ones can be done on an ipad and involve subjective questions, memory testing, reaction time, and cognitive tasks. I believe this should be mandatory for any kids involved in contact sport. It would allow to have a baseline for everyone in order to quantify the amount of damage caused after a head trauma.

Advanced neurological examination:

This would include analysis of eye movements. This method is already used to detect concussion. But brain dysfunction caused by long term effect of a concussion can also reveal abnormal eye movements. A detailed neurological examination can also reveal slowness in movement, deficits if balance or coordination, difficulty with rapid alternating movement (dysdiadochokinesia) which are all signs of brain dysfunction.

Active neurological rehabilitation:

The same way you rehabilitate a muscle after an injury, the brain can be rehabilitated after a concussion. This involves again eye movement and specific neuromuscular exercises. Several specialists across the country specializes in that type of treatment.

Hyperbaric Oxygen Therapy:

hyperbaric oxygen chamber has shown promising result for improving the brain function. It basically increases blood flow and oxygen supply in the brain, which is vital for recovery of neurological function.

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