What Neurologists Should Know About Concussion, the Film

Dr Conidi discusses some of the major points addressed in the blockbuster film that could impact clinical practice.

Often, when a movie comes out about a complex medical diagnosis, a flurry of articles rush to denounce the science. Will Smith’s Concussion needs no such censure.

In 2005, Bennett Omalu, MD, MBA, MPH, published his now-famous Neurosurgery journal paper, “Chronic traumatic encephalopathy in a National Football League player,” announcing the first documented case of long-term neurodegenerative changes in a retired professional National Football League (NFL) player which he deemed chronic traumatic encephalopathy (CTE). In it, he wrote, “This case draws attention to a disease that remains inadequately studied in the cohort of professional football players, with unknown true prevalence rates.”1

CTE’s true prevalence rates are still unknown, hindered by the current inability to diagnose those living with the condition and the politics surrounding neurological testing of active players. However, that doesn’t mean the topic has been silenced. In April 2015, the NFL reached a $1 billion settlement with thousands of former NFL players who suffered concussions, and research into CTE is ongoing. There is also no doubt that Will Smith’s portrayal of Dr Omalu will certainly boost visibility of these efforts.

RELATED: Rethinking Concussion Assessment

Researchers have been looking at the long term effects of concussion and sub-concussive hits on retired NFL alumni over the last decade. One such study commissioned by the NFL and conducted by the Institute for Social Research at the University of Michigan in 2009 found that 6.1% of all players over the age of 50 were likely to receive a diagnosis of dementia, Alzheimer’s Disease (AD), or other form of dementia, which is more than 5 times the expected rate in subjects of similar age in the general population. More shocking were the numbers on the 50 and under age group, who were 20 times more likely to carry one of the aforementioned diagnoses when compared to age-matched subjects from the general population. Overall, retired NFL players were found to be 3 times more likely to die of a neurodegenerative disorder and 4 times more likely to die of AD or amyotrophic lateral sclerosis (ALS), specifically.2

Perhaps surprising to an outsider is the lack of studies in active players. However, most NFL players and professional athletes in general are reluctant to participate in clinical studies for fear the results may be used against them to limit participation, terminate their career, or impact contract negotiations.