This morning’s news confirming that former NFL linebacker Junior Seau suffered from chronic traumatic encephalopathy (CTE) before his suicide in May again begs the question: what can be done by sports medicine professionals and the NFL to prevent or decrease the incidences of this condition?

Last month, Boston University disclosed that some 34 former pro football players had suffered from CTE. Seau, a 10-time All-Pro, now joins that list as perhaps its’ most prominent and accomplished football player. He was only 43 at the time of his death and less than three years removed from his final NFL appearance.

“I’ve been seeing patients with concussions for a long time,” says Todd Lewis, PhD. “and CTE isn’t something we see on a daily basis. That’s because we see a lot of younger athletes, and we don’t see the accumulation of multiple years of concussion and head trauma.”

Dr. Lewis is a Brain Injury Clinical Specialist at Magee Rehabilitation Hospital. He and Dr. Brian Kucer are co-directors of the Philadelphia Concussion Center at Magee Rehab. He added that in the past year, his colleague Dr. Kucer has seen someone suspected of having CTE.

“The patients we’ve seen in our clinic [with possible CTE] have been individuals at the highest level of athletics,” he continues. “These are former professional football players.”

Dr. Lewis confirmed that CTE isn’t something he sees in the weekend warriors or casual athletes who happen to sustain concussions. “Really, this is about the culmination of a number of concussions,” he said.

Dr. Lewis spoke of a patient he once treated who was headed off to college to play a different sport. “By the time this athlete came to our clinic, it was their 4^th or 5^th concussion,” he recalls. “What we’re lacking right now is that clear understanding of how many concussions does it take to begin the process, or breakdown of the brain from a neurochemical standpoint?”

In the cases of Junior Seau and a number of other former NFL players who committed suicide and were later found to have suffered from CTE, the circumstances surrounding their deaths leaves doctors and researchers to fill in the gaps. “Did these individuals shoot themselves in the chest because they believed they had CTE, and therefore wanted to preserve their brains for research?” Dr. Lewis asks.

In 2011, former Chicago Bear Dave Duerson sent a text message to his family before his own suicide offering explicit instructions to donate his brain for research. Three months after Duerson’s death, Boston University researchers concluded that he had suffered from CTE.

“What we’re seeing is not unlike dementia,” says Dr. Lewis. “Whereas you typically see dementia increase as time goes on—it’s more common when a person reaches their 70s or 80s— there are early stages of dementia. The correlation with these athletes who’ve been through multiple head traumas is we’re now seeing them suffering all the symptoms we would in someone with dementia from a cognitive standpoint.”

These symptoms include increased depression, irritability, and cognitive changes of loss of memory, problem solving and processing. After death, researchers are seeing atrophied brains that are much smaller than expected for the individual’s age.

Researchers agree that there’s a long way to go in terms of our overall knowledge of CTE and how it affects humans. What can be done with our current base of knowledge? “It starts with education,” says Dr. Lewis. “The more we get the word out there, the more we can take away the old-fashioned school of thought that you got ‘dinged’, that it’s a rite of passage and other ridiculous notions.”

Along with educating players and coaches, Dr. Lewis emphasized the importance at younger levels of sports of educating parents. “We see it in all areas of life—when a parent says or practices something, the child believes it,” he concludes. “So if mom and dad emphasize that ‘hey, you’ve only got one brain’—that child is going to be able to bring himself to say, ‘No, I’m not going back in the game.’”

-Rob Senior