The first soccer player to be diagnosed with Chronic Traumatic Encephalopathy (CTE) has drawn attention to the possibility that a sport formerly thought of as “safer” than football or hockey can still result degenerative effects on the neurological system.
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Patrick Grange died at age 29 in 2012 from a degenerative motor-neuron disease likely related to his amyotrophic lateral sclerosis or ALS, which is commonly known as Lou Gehrig’s disease.
After his death, Grange’s brain was found to have signs of the degenerative neurological disorder called CTE.
Grange, who played soccer on the collegiate level at Illinois-Chicago and New Mexico before spending time at the Premier Development League in Chicago, is the first soccer player confirmed to have had CTE, according to a New York Times report.
The disease can only be diagnosed after a patient's death when their brain is examined for certain protein patterns.
While CTE has been known to affect boxers since the 1920s, in recent years the disease has been diagnosed in players from a wide range of sports -- primarily professional football and hockey. Last year, the first baseball player was diagnosed.
Dr. Ann McKee, a neuropathologist at the VA Boston Healthcare System and the Boston University School of Medicine, worked to identify CTE in Grange’s brain at the CTE Center at Boston University. She said even subconcussive trauma, where no symptoms are experienced, can cause degradation of the brain.
“You can have limbs hitting the head and the head hitting the turf,” said McKee. “In addition, heading the balls and [the] velocity of the ball, there’s a substantial whiplash component. It’s an acceleration and deceleration” that can cause damage.
While soccer doesn't usually feature the big tackles and hits that are a hallmark of American football or hockey, the players often head the ball, sometimes thousands of times a year between games and practice. Researchers are now trying to understand what these repetitive actions can have on the brain.
Grange enjoyed heading the ball, according to the New York Times. His parents also told the Times that he showed signs of CTE very early and had trouble even balancing a checkbook, and impulsively left a job to try out for a soccer team.
Patients with CTE display symptoms "such as impulsivity, forgetfulness, depression, [and] sometimes suicidal ideation," according to Dr. Russell Lonser, chairman of the Department of Neurological Surgery at Ohio State University.
Dr. Michael Lipton, the associate director of the Gruss Magnetic Resonance Research Center at the Albert Einstein College of Medicine at Yeshiva University, has been studying the effects of heading the ball on soccer players for years.
“The lion's share of heading seems to come from practice. They head the ball again and again and again,” Lipton told ABC News. “From speaking to players, they will tell you they can become symptomatic during those drills ...[with] concussion symptoms related to competitive heading.”
Lipton said he’s talked to players who have experienced nausea, confusion and hearing loss during a drill.
“The thing that is unique about soccer is people are doing this again and again and again,” Lipton said of players practicing heading.
A published study of amateur adult soccer players found the more players headed the ball over a year, the likelier they were to exhibit signs of brain damage and inflammation on an MRI and have less cognitive function, Lipton said.
Another worrying sign in Grange’s case is the fact that he was diagnosed with ALS at just 27. McKee said it is extremely rare for a person as young as Grange to be diagnosed and that it is likely that the hits Grange took as player may have led to his CTE and contributed to his ALS.
According to the ALS foundation, most people who contract the disease are between the ages of 40 and 70.
At the CTE center, McKee said, they have found 13 people with both ALS and CTE and four were in their 20s. McKee said researchers believe those athletes may be suffering from a type of ALS connected to CTE.
“Much more work that needs to be done. We’re very interested in this connection,” said McKee. "It’s looking more and more that there’s a connection between ALS-like disease and traumatic injury.”
In 2004, an Italian study of 7,325 male soccer players found that the players were at an increased risk of contracting ALS, although it was unclear how or why they were more at risk.
Lipton said what has become clear is that repeated brain trauma from any kind of sport can lead to devastating consequences later on.
“I’m not convinced that this is the first case of CTE being related to soccer. My expectation would be as everyone’s is: There is nothing unique about football or hockey that leads to CTE; it’s repetitive trauma,” said Lipton. “The reason we haven’t seen soccer is really just a matter of recognition. It’s not on the radar in the same way.”