Symptoms from repeated intentional and unintentional head impact in soccer players

Stewart, Walter F.; Kim, Namhee; Ifrah, Chloé; Lipton, Richard B.; Bachrach, Tamar A.; Zimmerman, Molly E.; Kim, Mimi; Lipton, Michael L.

doi:10.1212/wnl.0000000000003657

Cited by 59 publications

(74 citation statements)

References 35 publications

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“…As part of an ongoing longitudinal study of adult amateur soccer players, 78 women and 212 men were recruited from amateur and collegiate teams from 2013 to 2016 (2,4,22). Subjects were considered to be eligible for inclusion in the source sample if they had played soccer at the amateur level for more than 5 years, were aged 18-55 years, and had been actively playing soccer for at least 6 months per year.…”

Section: Participantsmentioning

confidence: 99%

MRI-defined White Matter Microstructural Alteration Associated with Soccer Heading Is More Extensive in Women than Men

Rubin¹,

Catenaccio²,

Fleysher³

et al. 2018

Radiology

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Purpose To examine the role of sex in abnormal white matter microstructure after soccer heading as identified by using the diffusion-tensor imaging (DTI) metric fractional anisotropy (FA). Materials and Methods In this prospective cross-sectional study, 98 individuals who were enrolled in a larger prospective study of amateur soccer players (from 2013 to 2016) were matched 1:1 for age and history of soccer heading in the prior 12 months. Among the subjects, 49 men (mean age, 25.7 years; range, 18-50 years) and 49 women (mean age, 25.8 years; range, 18-50 years) with median total soccer headings per year of 487 and 469, respectively, underwent 3.0-T DTI. Images were registered to the Johns Hopkins University template. A voxelwise linear regression was fitted for FA with terms for the number of headings during the previous 12 months and its interaction with sex after controlling for the following potential confounders: age, years of education, number of lifetime concussions, and handedness. In the resulting statistical maps, P < .01 indicated a statistically significant difference, with a threshold cluster size larger than 100 mm. Results Among men, three regions were identified in which greater heading exposure was associated with lower FA; eight such regions were identified among women (>100 contiguous voxels, P < .01). In seven of the eight regions identified in women, the association between heading and FA was stronger in women than in men. There was no significant difference of heading with FA between the sexes for any region in which heading was associated with FA among men (P > .01, <100 contiguous voxels). Conclusion With similar exposure to heading, women exhibit more widespread evidence of microstructural white matter alteration than do men, suggesting preliminary support for a biologic divergence of brain response to repetitive trauma. © RSNA, 2018 Online supplemental material is available for this article.

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Section: Participantsmentioning

confidence: 99%

MRI-defined White Matter Microstructural Alteration Associated with Soccer Heading Is More Extensive in Women than Men

Rubin¹,

Catenaccio²,

Fleysher³

et al. 2018

Radiology

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“…61 Lipton et al further created self-report measures to estimate heading in soccer, known as the HeadCount or HeadCount-2w, which have predicted acute functional brain alterations in active soccer players. 36,38,62,63 Continued development and validation of RHI exposure measures across the different sports will greatly facilitate research on the short-and long-term neurologic effects of RHI. Exposure to RHI: The Importance of When Not all individuals exposed to RHI develop CTE and individual exposure differences may influence the pathological development of CTE.…”

Section: In Vivo Evidencementioning

confidence: 99%

Risk Factors for Chronic Traumatic Encephalopathy: A Proposed Framework

et al. 2020

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Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that has been neuropathologically diagnosed in contact and collision sport athletes, military veterans, and others with a history of exposure to repetitive head impacts (RHI). Identifying methods to diagnose and prevent CTE during life is a high priority. Timely diagnosis and implementation of treatment and preventative strategies for neurodegenerative diseases, including CTE, partially hinge upon early and accurate risk characterization. Here, we propose a framework of risk factors that influence the neuropathological development of CTE. We provide an up-to-date review of the literature examining cumulative exposure to RHI as the environmental trigger for CTE. Because not all individuals exposed to RHI develop CTE, the direct and/or indirect influence of nonhead trauma exposure characteristics (e.g., age, sex, race, genetics) on the pathological development of CTE is reviewed. We conclude with recommendations for future directions, as well as opinions for preventative strategies that could mitigate risk.

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“…In their article "Symptoms from repeated intentional and unintentional head impact in soccer players," Stewart et al 1 explore the link between heading the soccer ball and the development of neurologic symptoms. In contact sports, most notably football, 2 there is a link between so-called subconcussive hits and the development of long-term neurologic symptoms.…”

Section: Soccer and Head Injuriesmentioning

confidence: 99%