Preventing concussions key, Duke neurosurgeon says

Jul. 29, 2014 @ 07:35 PM

Tuesday’s settlement between the NCAA and a group of former players over the way head injuries were handled means changes are coming to how athletes are treated by medical staffs.

Once the agreement is finalized, baseline neurological testing of all athletes at the start of each school year will be mandatory. That will help doctors determine the severity of a new injury.

Coaches and athletes will also go through mandatory concussion education. Plus, a new, independent Medical Science Committee will be created to oversee the medical testing.

While those measures are looked upon as positive, Duke University neurosurgeon Dr. Carlos Bagley said the next important step in dealing with concussions is for resources to be shifted from treatment to prevention.

“I think there is some genetic susceptibility in some individuals versus others,” Bagley said. “In my mind, I think that’s really where the Holy Grail is.”

Bagley is intimately familiar with athletes, coaches and concussions. He played linebacker for the Blue Devils from 1992-95 before earning his medical degree from Duke in 2000, followed by a residency at Johns Hopkins.

He’s seen how different people’s brains react to circumstances.

“Anyone who has been around folks who get concussions, there are some folks that get them,” Bagley said. “You sneeze on them and they get a concussion. And then there are others who can run through a brick wall and, as best you can tell from all objective measures, they are just fine.”

That’s why with all the resources being funneled to treatment and determining when an athlete is safe to return to play following a concussion these days, Bagley thinks about the next step — stopping them from happening in the first place.

To do so would mean cracking the genetic code that determines who is most likely to get a concussion. It’s the same approach researchers are taking in other areas of medicine, like with different types of cancers or with heart disease.

“I think there is a genetic susceptibility,” Bagley said. “If you can identify those folks and then establish where the threshold is … There are so many folks that play Pop Warner, high school, college. There are thousands and thousands or millions of folks who have played at the various levels, and to understand where that threshold is or to understand where that switch is, it’s about identifying the folks at highest risk so you can advise them.”

Football is just one sport where concussions and other head injuries are an issue. Soccer, hockey and the increasingly poplar mixed martial arts competitions also carry high risks.

The NCAA and the plaintiffs in the lawsuit settled on Tuesday have agreed to a $70 million fund to test and monitor former athletes in a variety of sports, not just football, for neurocognitive issues.

Bagley admits that, currently, there’s not much knowledge about who is susceptible and who isn’t. While large sums of money are being allocated at the college and professional level to deal with the damage that’s already done, he hopes the next few years see prevention get more resources.

“Just like with anything in medicine,” Bagley said, “it’s great to treat the disease process, but how can we prevent the disease from occurring in the first place? That’s really the key. It’s something we don’t know too much about, but hopefully, over the next decade or so with resources going toward studying the phenomenon, we can appropriately counsel folks.”