Concussions now a big part of retirement decisions

Wrestling fans are excited about the recent return of Daniel Bryan to the ring. Bryan, a star performer, was forced to retire two years ago due to multiple concussions. His return after multiple, comprehensive neurological evaluations has raised many questions regarding the criteria for medical retirement from sports after concussion.

Concussion is best defined as a group of neurologic symptoms that arise after a force is applied to the brain. Recovery from these symptoms can vary but the general accepted time frame is 10 days. This is often longer in children. The persistence of these symptoms is associated with post-concussion syndrome.

Repeated blows to the brain can result in permanent impairment with persistent headaches, cognitive difficulties, sleep abnormalities, emotional disturbances and other neurologic symptoms.

The often-asked question is: "How many blows can the brain tolerate before resulting in permanent damage?"

The human brain is a highly individualized organ. It consists of a mass of nerve cells that each has a threshold for injury. The challenge for physicians is to determine that threshold based on the symptoms suffered and the length of the recovery period.

There are some basic rules that indicate the need to retire from participation in high-velocity collision or combat sports. These include:

1. Persistent abnormalities on cognitive and psychological testing that can be linked to concussion
2. Structural abnormalities found in the brain that may be related to trauma or predispose the athlete to permanent injury
3. A demonstrated decreased threshold for injury over multiple, successive concussions

Another recent change in the presentation of sports-related concussion has been the desire to voluntarily withdraw from high-risk sports. Athletes, even at the highest levels of sport, are choosing that the risks outweigh the benefits.

In the case of Bryan or any other athlete, it is worth the time investment to seek out a highly qualified physician who works with athletes.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

NFLPA draws up a playbook for player safety

A playbook is a collection of strategies that allows a team to deceive their opponent at crucial times during the course of a contest. Football players are aware of the importance of their playbook and the secrecy that surrounds its contents. The National Football League Players Association (NFLPA) has taken the playbook concept and applied it to improving the health of all its members and their families.

The recently released NFLPA Health Playbook is a compendium of easy-to-understand health information that addresses common illnesses facing both active and former players. It was designed and written by members of the NFLPA Mackey-White Health and Safety Committee. It is divided into four broad sections:

1. Performance
2. Medical diseases and conditions
3. Orthopedics and musculoskeletal conditions
4. Neurology and neurotrauma

Specific topics were chosen based on information obtained through research conducted as part of the Football Player Health Study at Harvard University.

The performance section discusses the evaluation and treatment of sleep disorders, as well as a variety of mental health disorders. Among the medical conditions, diabetes mellitus and the potential complications from it are explained along with a variety of treatments. This section also addresses hypertension, hypercholesterolemia and peripheral neuropathy. The chapters covering neurologic conditions and concussions are highly informative.

“The NFLPA is committed to ensuring that our player members receive the best medical care in the world,” reports Sean Sansiveri, NFLPA vice president of business and legal affairs. “This playbook serves as our latest effort to equip players and their families with the knowledge and resources necessary to achieve overall wellness for their betterment as people and patients.”

Although the NFLPA Health Playbook provides a concise, thorough review of health topics designed to support active and former football players, it is actually an excellent guide for all athletes and the general public.

Like other playbooks, the health playbook will be continually updated as new medical issues and treatments develop. The full publication is available online as a courtesy of the NFLPA, and can be found by searching “NFLPA Health Playbook.”

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu.

Cavaliers’ Love shines light on panic attacks

In a recent article published online in “The Players’ Tribune,” Kevin Love of the Cleveland Cavaliers, discussed his ongoing battle with panic attacks. Although the condition is not rare, anytime a professional athlete admits to a mental health condition it becomes noteworthy.


A panic attack is an episode of intense fear when no apparent danger is present. The person feels a sense of impending doom and loss of control. This triggers a reaction with symptoms that can include: a rapid, pounding heart rate, sweating, trembling, difficulty breathing, nausea, chest pain and numbness. There is often a feeling of unreality or detachment.


This cascade of symptoms is also known as the “fight or flight response.” This is a primitive response designed to protect a person when threatened by an attacker. This complex reaction begins in the brain where the amygdala and hypothalamus respond involuntarily to a situation. This occurs without conscious input of judgment provided by the frontal lobes.


These structures in the brain then send signals to the adrenal glands to secrete adrenaline that in turn causes the physiologic response described.


Successful athletes are able to trigger this response to their advantage and as a result can improve performance. In the case of Love, his false perception of danger has caused episodes where he temporarily cannot function at a high level.


“Current treatments include medications and behavioral interventions designed to identify and reduce the symptoms. One of the best treatments, in the short term, is an anti-anxiety medication,” reports Dr. Caleb Peck, a Norwich neuropsychologist and Director of Clarus Health Alliance. “The best treatment outcome comes from pairing medication with individual psychotherapy.”


Love’s admission of a mental health condition, coupled with his level of fame, will hopefully lead to other athletes seeking care.


Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu












Studies reveal risks for spinal injuries

Among the most terrifying injuries in sports is when an athlete becomes paralyzed after a collision or fall. If the impact is focused on the cervical spine, the result is a temporary or permanent paralysis of all extremities. This pattern of paralysis is referred to as quadriplegia. Identifying athletes who may be susceptible to this type of injury can be lifesaving.

The cervical spine consists of seven bony vertebrae that surround and protect the spinal cord.

Cartilaginous discs that cushion and protect the bones from friction and impact separate the vertebrae. The individual vertebral segments are connected by a series of ligaments giving this portion of the spine flexibility to allow a certain degree of bending and twisting.

The cervical spinal cord is located in a central canal. The spinal cord at this level contains a network of motor and sensory nerve fibers that carry signals to and from the brain. The higher levels also coordinate essential functions such as respiration, temperature and cardiac function.

The most common injury is known as neurapraxia of the cervical spinal cord. This is best described as transient numbness, tingling and/or weakness of the extremities after cervical cord injury. It typically occurs with hyperextension, flexion or axial loading of the spine. Episodes last anywhere from 15 minutes to 36 hours. Axial loading injuries are common in football when tackling with the head down.

Subsequent radiologic studies often reveal congenital narrowing of the cervical canal causing these athletes to be vulnerable to this type of injury.

“Initial treatment for congenital cervical stenosis is often observation,” reports Dr. Isaac Moss, Associate Professor of Orthopaedic Surgery and Neurosurgery at the University of Connecticut. “However, if patients become symptomatic, surgical treatment is an option. This is often in the form of a procedure called laminoplasty, which involves increasing the space available for the spinal cord within the spinal canal.”

A thorough neurologic evaluation for episodes of weakness and numbness in athletes can avoid catastrophe.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu





New concussion blood test shows promise

A concussion is brain trauma brought on by a biomechanical force. It consists of a group of neurological symptoms that impair the patient for a variable amount of time. The symptoms are often not immediately obvious to the patient or an observer, making the diagnosis of a concussion challenging.

The recent announcement of an FDA-approved blood test that can help resolve this diagnostic dilemma has been met with great interest both by the public and the scientific community.

A biomarker is a measurable substance in an organism that may indicate the presence of a disease, infection or environmental exposure. The Banyan Brain Trauma Indicator is based on identifying proteins that are released from the brain into the bloodstream after impact.

The specific proteins detected by this test (UCH-L1 and GFAP) can be identified up to 12 hours after injury. The blood sample takes approximately three hours to process. The principal studies were conducted by the Department of Defense in soldiers who experienced brain trauma.

Brain trauma has become a significant health problem in the United States. There were approximately 2.8 million visits to the emergency room in 2013. Currently, there are approximately 3.8 million sports-related concussions each year in the United States. This discrepancy is based on the fact that brain trauma is a range of injury that includes brain trauma from severe motor vehicle accidents and penetrating trauma from blasts and gunshots. Concussion is the mildest type of brain trauma on this range and often does not require brain imaging such as CT scanning.

Currently this new blood test has very limited application in sports, where decisions need to be made quickly and away from a laboratory. It is also not useful in identifying sub-concussive blows to the brain that result in cumulative injury. It is not approved for use in children at this time.

This blood test will be helpful in an emergency room setting after serious brain injury.

Despite its limitations, the Banyan biomarker is a significant advance in the diagnosis of brain trauma and will hopefully lead to better testing.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu






The danger of sexual predators in sports

The recent conviction and sentencing of Larry Nassar should be a reminder to all that vigilance is necessary to protect children from predators.

More importantly, Nassar violated an established trust between a patient and physician. This and other recent episodes of abuse have also shattered the faith placed in organizations and universities entrusted to protect young athletes.

Sexual predators often methodically build relationships with victims over a period of years. The underlying premise in many abusive situations is the exertion of power over a victim. Early recognition of typical behaviors can avoid a potential crisis.

Grooming is one technique used by predators. It is a process by which an offender draws a victim into a sexual relationship and maintains that relationship in secrecy. Typical targets are young, unsuspecting athletes who have low self-esteem and little parental oversight. Athletes with intellectual impairments can be particularly vulnerable.

Establishing a bond with the athlete and parents allows a sexual predator a lot of opportunity.

Private coaching or physical treatments specific for that athlete can be warning signs.

Isolation is also a crucial element in an abusive relationship. Participation on travel teams and competitions that require overnight accommodations can present occasions for abuse.

Excessive physical contact that appears inappropriate can also be a sign of abuse. If physical contact is necessary in the course of a medical examination, a parent or other adult should be present. The practitioner should welcome inquiries regarding the nature of the examination. Unfortunately, many young athletes actually report incidents of abuse but are not taken seriously.

There are many dedicated coaches, medical personnel and parents involved in youth sports. Vigilance on the part of all adults involved in youth sports is crucial to stopping what has become a disheartening trend.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu.







Diet, exercise prove helpful in treating MS

Multiple sclerosis (MS) affects at least 400,000 Americans and two million people worldwide. It is a chronic inflammatory disorder that targets the brain and spinal cord. Specifically, the immune system attacks the insulation around nerves as if attacking a foreign object.

MS often presents with symptoms of visual loss in one eye, weakness, numbness, double vision or difficulty walking. The course of the illness is typically marked by periods of deterioration lasting days or weeks followed by remission.

Approximately 15 percent of patients have a progressive unremitting course of illness.

Although there is no cure for MS, there has been tremendous progress in the development and use of disease-modifying medications that increase the length of the symptom-free periods. The goal of treatment is to redirect the immune system.

In addition to medications, several other modalities in the form of diet and exercise have been proven to be helpful in treating MS.

MS is most commonly found in temperate climates where exposure to sunlight is reduced. Vitamin D supplements have been shown to be helpful in treatment.

Diets rich in whole grains, fruits and vegetables with reduced intake of processed sugars and red meat is optimal.

Interestingly, regular physical exercise has also demonstrated a beneficial effect in maintaining patients’ neurologic function. Moderate aerobic exercise combined with light resistance exercise has proven to be an effective regimen. Overheating the body from vigorous exercise or use of a hot tub can be detrimental.

“A structured exercise regimen that allows for gradually increased intensity under the guidance of a physical therapist and a physician can provide a benefit for patients with MS and other neurologic diseases,” reports Dr. Vernon Williams, Director of Sports Neurology at the Kerman-Jobe Clinic.

MS patients should consider multiple treatment modalities.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Go slow with new exercise routine

Among the most popular New Year resolutions is weight loss. Beginning or resuming an exercise program after a long lay-off can result in significant injury that will impact a weight-loss program.

Exercise is an intricate part in regulating how much a human eats, drinks and sleeps. It dates back to hunting and gathering activities. In addition to these essential functions, exercise is key to cardiovascular, neurologic and mental health. Recent studies have also indicated that exercise has a protective effect against certain forms of cancer and dementia.

One pressing question remains: “How much exercise is needed to acquire the potential health benefits?” The best current data indicates that even light exercise can provide a big advantage.

Recent studies indicate that consistent daily activities including dog walking, housework, opting for stairs instead of an elevator or even performing home chores can result in improved overall longevity. The greatest benefit comes from 30 minutes of moderate to vigorous activity. This level of activity can reduce the risk of death by 50 percent.

One of the first steps toward a healthy activity program is to incorporate more standing and less sitting. The human body was not designed to withstand the stresses of prolonged sitting. Modifying a workstation to allow for periods of standing can produce a positive result.

An enthusiastic return to the gym should be tempered by the potential for injury. Light aerobic exercise in the form of walking on a treadmill, riding a stationary bike at low resistance or using an elliptical machine at no incline can be a good introduction.

Measuring steps with the use of a variety of technologic devices can provide a big boost to a walking program. A goal of 10,000 steps per day is ideal but any steps are a move in the right direction.

The operative message to beginning a safe exercise regimen is to get the approval of a physician and start slow.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu