According to the Center for ECT from Boston University, chronic traumatic encephalopathy, or ECT, has plagued boxers since the 1920s. However, it did not emerge into the national consciousness until 2007, when The New York Times reported that Andre Waters had suffered brain damage from playing American football, which led to his depression and later to his suicide.
Degenerative brain disease associated with repeated blows to the head has been detected in the brains of more than 315 former NFL players. Waters was the third, but his death made the condition known on a massive scale. That group includes 24 players who died between the ages of 20 and 40, according to Ann McKee, a neuropathologist and director of the Boston University ECT Center.
After their deaths by suicide, Junior Seau, 43, Waters, 44, and Dave Duerson, 50, were found to have ECT, as was Jovan Belcher, a 25-year-old linebacker for the Kansas City Chiefs who killed his girlfriend before shooting himself in the head in 2012; Aaron Hernandez, a 27-year-old former New England Patriots tight end who committed suicide after being convicted of a 2013 murder; and Phillip Adams, a 32-year-old NFL cornerback who shot and killed six people in April 2021 before killing himself. It was also recently determined that Vincent Jackson, a veteran wide receiver for the San Diego Chargers and Tampa Bay Buccaneers who was found dead in February, had a mild form of ECT.
Here’s what to know about ECT.
What is ECT?
The ECT, which can only be diagnosed after death, has been linked to a number of symptoms, including memory loss, depression, aggressive behavior, and sometimes suicidal thoughts. It is a progressive disease, and symptoms can emerge long after head banging has stopped.
Although the condition has been most commonly associated with football players, ECT it has been found in the brains of boxers, hockey players, soccer players, a bobsleigher, and other athletes.
Do concussions cause ECT?
Diagnosed concussions are not reliable indicators of ECT. About 20 percent of people discovered with ECT never had a diagnosed concussion, according to doctors at the Boston University ECT Center, who analyzed Jackson’s brain.
Studies have shown that smaller, more frequent blows to the head that do not cause symptoms are more predictive, known as subconcussive blows. Studies show that the severity of ECT increases the longer a football player’s career is.
What are the stages of ECT?
McKee developed a staging system, ranging from mild (stage 1) to more severe (stage 4), for coding ECT pathology. Although there are general trends, there is no clear delineation of symptoms within those stagessaid Chris Nowinski, co-founder and CEO of the Concussion Legacy Foundation.
“The brain has 86 billion neurons,” Nowinski said in a telephone interview. “We are talking about almost microscopic lesions. The location of the lesions and the way your brain is wired will likely have more impact than staging. An injury that is a millimeter in the other direction could be the difference between normal behavior and disability.”
Stage 1 is the earliest sign of ECT. The lesions are primarily in the frontal lobe, and symptoms often include mild memory loss. In stage 2, the lesions spread to the adjacent cortex, continuing their assault on memory. According to Nowinski, damage to the frontal lobe is known to be linked to problems with concentration, cognition and impulse control. Examination of Adams’s brain, which was revealed to be stage 2, indicated an abnormally severe diagnosis for a person in his mid-30s, similar to that found in Hernandez, who was diagnosed as stage 3 by McKee, in which the lesions have taken over the medial temporal lobe, affecting the hippocampus and cerebral amygdala, causing violent and impulsive reactions; paranoia; and memory erosion.
According to Nowinski, the vast majority of people who are in stage 4, in which ECT has spread to multiple parts of the brain, have been diagnosed with dementia. He said the trend is for 13 years to pass between stages and that people over 60 with ECT are almost always found to be in stages 3 or 4.
What has been the impact of ECT on the NFL?
Hall of Fame center Mike Webster was the first NFL player to be discovered with ECT. The result of that examination was published in a scientific journal three years after his death in 2002. More than 315 former players, including Ken Stabler and Frank Gifford, have been posthumously diagnosed with ECT. Researchers at Boston University announced in a 2019 study that football players exposed to constant tackling double their risk of developing the worst forms of ECT every 5.3 years they play.
For many years, the NFL denied any connection between long-term brain damage and head impacts, until faced with overwhelming scientific evidence. When it became known that a group of former players had filed a class action lawsuit, the league acknowledged the connection and reached a settlement of approximately $1 billion; since then The NFL has agreed to stop using race-based methods to assess insanity claims that denied benefits worth hundreds of thousands of dollars to black players.
In response to the increasing prevalence of ECT, the NFL has developed intensive protocols for players who have, or show signs of, head injuries. The league installed a head injury observer in the press boxes for every game; doctors and traumatic brain injury specialists on the sidelines; and neurocognitive testing experts in the locker room. The league has also tightened the rules around impact against quarterbacks and players who lower their helmets to initiate contact.
Can ECT be treated?
There is no known cure for ECT, and since it cannot be accurately identified in the brains of living people, the disease itself cannot be treated. However, some medications and therapies can help control symptoms and regulate moods and behavior.
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