Brain concussion - shake it and you break it | Steven Laureys | TEDxLiège

Steven Laureys MD Ph.D., is director of the Coma Science Group (http://www.comascience.org) at the GIGA Research and Neurology Department of the University and University Hospital of Liège, Belgium. He is Research Director at the Belgian National Fund for Scientific Research and board-certified in neurology and in palliative medicine. He is president-elect of the Association for the Scientific Study of Consciousness and  chair of the World Federation of Neurology Applied Research Group on Coma. His team studies acquired brain injury and altered states of consciousness (e.g., comatose, “vegetative”/unresponsive, minimally conscious and locked-in syndromes),confronting clinical expertise and bedside behavioral evaluation with neuroimaging. They also deal with the ethical implications of this translational clinical research.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

(Distorted voice) I love boxing.

I love boxing.

But today, I'm here as a neurologist,

and that "T" stands
for traumatic brain injury.

And if there is one thing
I'd like you to remember of this talk,

that's this:

when we're talking about the brain,
talking about the brain, you should know

that when you shake it, you break it.

And I'm going to talk
about blows to the head, concussions.

And that has an impact, years later,

where these athletes develop
a chronic progressive brain disease.

Now, let's start the slides,

and let me share

some of my childhood memories.

When I was a little boy,

I loved watching sports on television -
boxing - with my daddy.

Now, he was a heavy smoker.

We had a black and white
television screen,

and sometimes I'd barely see the screen

because it was a small
living room full of smoke.

And I remember one of those fights.

1978.

We were watching our hero,

the greatest, Muhammad Ali.

Our rebel.

I don't know if anyone here
remembers this fight,

the historical one against Leon Spinks.

Who won this fight? Las Vegas?

Come on!

Muhammad Ali.

Of course! He always won!

"Float like a butterfly,
sting like a bee."

Now, this was a special fight

because it would be
the last one he'd ever win.

And I remember, again,
watching television with my daddy,

1996 Olympics.

You remember that?

By that time, I was a medical student.

And I was shocked.

I think everybody who remembers Ali

trying to light that Olympic flame.

The butterfly was broken.

Because his brain was broken.

He was so much worse, 2012,

again, the opening
of the Olympics, London.

He could no longer walk without help.

He couldn't talk.

I watched that without my dad,
who died from lung cancer,

and I think it's difficult to be certain

that my dad would still be here,
would not have gotten lung cancer,

if he wouldn't have smoked
so many cigarettes.

And I think it's hard to be sure

that Muhammad Ali

would not have developed
Parkinson's syndrome,

if he wouldn't have taken
so many blows to the head.

But again, it's highly probable.

And of course, we know
boxing is a dangerous sport.

There's - you see here -

boxers dying in the ring.

You see, every 10 years,
how many of these young athletes die.

And we did something about it, right?

You see, in the 1920s,
there was nearly 200.

10 years, dying, and we changed the rules,
made better equipment.

So the number of deaths went down,

but still, see now, about every 2 months

somewhere in the ring a boxer dies.

The first time I was
personally involved in this,

I remember,

at the University Hospital here in Liège

as a neurologist, seeing this father.

He was desperate.

He came to see me, wanted to tell

because his son, he was very proud -

his son was strong, was a great athlete.

He was an international
champion, kickboxing.

He won fight after fight
until that last fight

where he received
the blow to the head so bad,

he not only lost the fight,

but when I saw him -

and I think it's easy to see here
which is the brain from the fighter

and which is the normal brain, right?

So what you see here, it's all blue:
we're looking at brain activity.

So we basically inject sugar.

You should look all red and yellow -
very high activity, I hope.

There the lights went out. It's all blue.

What I can tell you -
we are now eight years later -

he will never fight again,

he will never even be
thinking about fighting,

he will not be thinking about anything.

That's something very visible:

the direct brain damage, the knockouts,
in this case, the coma.

But what I want to talk about
is something much more invisible

and yet very real:

the indirect effects,

the chronic brain disease

that you can develop
when you receive blows to the head.

And we know that -
this is not something new.

Here a paper, 1928.

Doctor Martin publishing in the journal
of the American Medical Association.

The title is "Punch-Drunk Syndrome."

Punches to the head,

and afterwards, these boxers
are like they had too many drinks.

What he did, you see 23 boxers,

and he looked at what
became of them, years later.

You can read it.

Parkinson was already known, 1928.

Drags the leg, bad shape,

talks slow.

Four in the asylum, OK?

So we can't say we don't know this.

Let me show you what's inside here:

actually a real brain.

This is what yours look like.

Let's look at a boxer's brain.

OK, again, don't have to show
which is the boxer's brain.

This is an athlete who had a career.

Years later, you see the consequences.

This looks like a brain
of somebody a hundred years old.

It's very small, like a demented elderly.

Let's look inside, OK?

We call this "pugilistic dementia,"
from the Latin, or actually Greek "fists,"

fighting, OK?

Blows to head can make you demented.

And we know what's going on.

There's different stages.

You see here stage 1 and 2 and 3.

We see slices of the brain.

And the brown spots,
that's where there is a disease.

Actually, it's an abnormal protein,
it's toxic for the brain.

And it goes on with time,
and we have no cure.

Let's look at Stage 3.

That red circle is actually
an important part of your brain;

it's here in the temporal lobe,

and that's important for emotions.

So these boxers,
years later, decades later,

they show personality changes,

mood swings.

They can become depressed
and commit suicide.

We know why.

That's that red circle.

This region, it's all black,

there's a lot of abnormal cells there -

stage 4, it's all brown,

it's a full-blown dementia.

We know it, and we should do
something about it.

And one could say, well,
you know, Muhammad Ali,

maybe he would have been a gardener,

and still, you know,
develop Parkinson's disease.

Here is scientific evidence.

22 scientific studies.

You see those red dots?

When they're on the right,

it means that this study showed a link

between brain concussion and trembling,

this degenerative disease.

It's clear.

There's like only three
where there is no link.

You shake it, and you break it, OK?

And we have no cure for these diseases.

Another study.

See, the number of professional fights -

10, 20, 30 -

and then in blue, you have boxers' brains,

and in red;

it's a big cohort.

90 over 90 under 30 - mixed martial arts.

You see, the more fights they have,
the smaller their brains become.

So, should we promote a sport

where the aim of the game
is to hit the other's brain?

We should think about this.

And I think

there is three things we should do.

That's change the rules to make it safer

and improve the equipment
to make it safer.

That's what I show here.

In 1984,

the International
Olympics Committee decided

boxers at the games
should wear helmets, OK?

I don't know if you know

but in Rio, the Olympics,
they will be boxing without a helmet.

They decided, you know,
for male boxers, no longer necessary.

As a neurologist, I know
and the evidence shows

this is a bad, a sad decision.

So what's happening, actually,
in the brain, this fragile organ,

when you take a blow to the head?

There's acceleration injuries.

Look at here, Joe Frazier
hitting the fist of Muhammad Ali.

These are huge forces.

This is like you driving in your car,
hitting a concrete wall, OK?

You can have your safety belt,
you can have an airbag;

there is no zero risk here.

Actually, this is not only true for boxing

or those sports where the aim of the game
is to hit the other's brain.

It's also football, ice hockey,

and we see rugby players
here at University Hospital in Liège,

where head-to-head contact.

That's not good,

and a helmet can protect you.

It's much harder for these helmets

to protect you
from those rotational forces.

You remember Rumble in the Jungle -

big fight in Kinshasa against Foreman?

Can you imagine this blow
Foreman receives to the chin?

His brain is twisted.

I can tell you, he lost connections
at that very moment.

And that's very hard
for a helmet to compensate for.

So we should change the rules,
improve the equipment,

and we should monitor these athletes,

have surveillance.

At the University Hospital here in Liège,
we see these young rugby players,

and when they have
a knockout, a concussion,

we'll see them, we'll test them,

and we can look inside their brain,
that's what you see here.

And you basically see
these colors here are like the branches.

You see the fragility, OK?

Shake it, and you break it.

That's not a good idea.

We can see those damages and protect them

from later on developing
these progressive degenerative diseases.

So let me end by citing again

my hero rebel, Muhammad Ali,

when he says,

"I think boxing is dangerous.

The brain's a delicate thing."

And I'd like to add to that

that we can and we should
make boxing less dangerous.

Isn't it strange that about the rules

you can't hit below the belt, right?

You hit the head, you get points.

We should change that, and we can.

Just as you get penalty points
when you hit below the belt,

you get penalties when you hit the head.

Just hit the body;

keep the sport but change the rules.

Next, isn't it strange

that we're worried and we protect -

it's mandatory to fight
all the [inaudible] with protection?

(Three knocks)

(Laughter)

I have one.

(Laughter)

And we protect your teeth,

and we don't seem to care
about the brains?

Now, these are important.

(Laughter)

But it's way less fun without a brain.

(Laughter)

(Applause)

So, we know this disease.

It's not about the direct effect,
the knockouts, people dying.

We should try to avoid
this chronic disease

where we have no cure,
so we need to prevent it.

Change the rules, better protection

and better surveillance.

Because we don't want
our children's children

to watch sports, to do sports -

well, we hope they will not be smoking -

and also, they won't be exposed to sports

where the aim of the game
is to damage the other's brain.

We don't want to go back to Roman times,

you know, looking at boxing gladiators
killing each other.

We don't want no future

with "Hunger Game"-like problems.

We can and we should make sport
healthy and safe for body and mind.

Thank you.

(Applause)