Management of chronic traumatic encephalopathy

ABSTRACT

Introduction: Chronic Traumatic Encephalopathy (CTE) is a neuropathological disease defined by perivascular hyperphosphorylated tau protein depositions in a patchy distribution at the depths of cortical sulci in the brain. Presently, in living individuals, it cannot be precisely diagnosed or differentiated from other neurodegenerative diseases nor are there treatments for the underlying disease process. There are non-pharmacologic and pharmacologic treatments for the symptoms of CTE that improve the quality of daily life. That is the primary focus of this review article that used Pub Med and other standard databases but drew heavily from the author's personal experience managing patients at risk for CTE.

Areas covered: The history and pathology of CTE, aiding the clinician diagnosing CTE as unlikely, possible, or probable in the living, and symptom treatment are the major areas discussed.

Expert opinion: Diagnosing CTE during life with sensitive and specific biomarkers is the next critical step and only then will its incidence and prevalence, risk factors, and clinical features due to tauopathy versus axonopathy or other features be known.

KEYWORDS:

• Chronic traumatic encephalopathy (CTE)
• cognitive
• behavior/mood
• ocular
• vestibular
• motor and exercise therapy
• pharmacologic treatment of agitation
• apathy
• attention

Article highlights

• While CTE has been known for over 100 years it is only recently that it has been shown to be far more prevalent than suspected.

• While with certainty CTE can only be diagnosed by neuropathological criteria post-mortem, this paper provides a roadmap for the clinician to more accurately suspect CTE in the living as being unlikely, possible, or probable.

• While there are now more than 100 papers published annually, none to date have addressed its management.

• This paper provides direction to manage the clinical symptoms of CTE with pharmacologic and non-pharmacologic therapies that can improve the quality of daily life.

• While early detection of CTE prior to the onset of symptoms is not presently possible, using repetitive head impact exposure and clinical symptoms a high index of suspicion of CTE can occur and therapies instituted.

Declaration of interest

R Cantu acts as a senior advisor to the NFL Head Neck & Spine Committee, Vice President of National Operating Committee on Standards for Athletic Equipment. He is also Chair of the Scientific Advisory Committee, Co-Founder and medical director to the Concussion Legacy Foundation. He has also received royalties from Houghton Mifflin Harcourt and Legal Expert Opinion. He has also acted on the medical science committee for the National Collegiate Athletic Association Student-Athlete concussion injury Litigation. A Budson has received royalties from Oxford University Press and Elsevier as well as consultancy fees from Pirimal Imaging and Biogen. He has also received grant support from Biogen and the Department of Veterans Affairs and has been a clinical trial investigator for Eli Lilly, Biogen, Cognito, and Avanir. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.