SQ Exclusive Interview With Dr. Harry G. Kerasidis, Concussion Neurologist
by 12 January 2016, 12:45 PM
Everything you’ve ever wanted to know about concussions, from a renowned neurologist.
Concussions are an insanely hot topic in the world of sports, at all levels of the game. It’s even come to light in general pop-culture with the release of the new film, Concussion. The most important thing about concussions though, is education. At the forefront of concussion research is Dr. Harry G. Kerasidis, renowned neurologist and co-founder of XLNTbrain LLC, a sports concussion management program for teams and players in all sports, at all levels. I interviewed Dr. Kerasidis on his background in neuroscience, the biology of concussions, and his thoughts on the NFL.
GAURAV SHASTRI: How did you get into neuroscience and concussion analysis?
DR. HARRY G. KERASIDIS: I had always been interested in science. Never played organized football myself, but I played a lot of pickup football as a kid. Once, when I was in college, I was playing street football with my friends and actually sustained my own concussion. The experience of having my brain not working properly alerted me to interesting aspects of the brain and consciousness. And that led me to pursue neuroscience and become a physician.
What are your thoughts on the current state of player safety policy in organized football at each different level?
It varies at each level. At the professional level, I have many concerns about policy being affected by conflict of interest due to the simple fact that, well, there’s a lot of money involved. Athletes don’t want to be pulled, and teams don’t want their athletes to be pulled. Even the team doctors may be influenced. However, I’m happy about the recent shift to independent physicians analyzing concussions at the professional. Even at the high school and college level, there can be conflict of interests with parents and coaches. Until very recently, there was never enough people on the sidelines advocating for the health of the people involved.
Is there a “safe” way for kids to learn to play that comforts worried parents and also reduces chances of suffering such head injuries?
Definitely. The first thing I always say is that sports, all sports, are extremely important and valuable to our youth. Study upon study shows the effect that participation in sports has on academics, and life in general. The main point though, is that when managed properly, the benefits outweigh the risk. This can be done through prevention, education, and responsibility. On my website, I talk about something I call the “Four R’s”―Recognize, Report, Recover, and Responsibility. The last one being the key.
For our readers who may not know, what exactly does a concussion do to your brain?
The brain operates on electrochemical principles. It requires a great deal of the ability of the membranes of cells to maintain a gradient of electrolytes inside and outside of the cell. What happens is that the trauma directly injures the brain cells, causing them to be “leaky”. Sodium rushes in, Potassium out, and the cells get all out of whack, and just can’t work as well.
And that affects glycolysis?
That’s exactly right. The ability for the cells to bring fuel for the cells is extremely impaired. This causes a mini “energy crisis” within the brain. This can also cause increased lactic acid, which further leads to toxicity in the brain. The most valuable way to treat these going-ons, post-concussion, is to rest so that the brain can get its systems back to working order.
What are some common symptoms of a concussion?
Migraine like headaches, sensitivity to light and sound, and nausea are the most common symptoms. Cognitive symptoms can include foggy thinking, deer-in-headlights persona, confusion, and difficulty concentrating. There may also be many sleep, mood, and balance related complaints from those who are experiencing a concussion.
How can one determine if they have CTE (chronic traumatic encephalopathy)?
That’s the holy grail of neuroscience right now. Unfortunately, it’s extremely difficult to ascertain. We don’t really know the risks. It’s very alarming to hear that the brain bank used for research has 80 brains, and 79 of them had CTE. Now to be fair, that’s a biased sample of people that chose to donate, so what about thousands of other who did not donate their brains? We don’t have a clear picture of risks, but despite this, it’s clearly a huge concern. In NFL players, those who have had multiple concussions may have CTE twice as much as those that have not at 50 years old. However at 75 years of age, the risk is the same. This may correlate CTE to early onset dementia.
How does CTE affect the biology of the brain at a molecular level over time?
The deposition of tau protein, one of the pathologies associated with Alzheimer’s disease. There are many similarities with Alzheimer’s. A main difference, however, is the pattern of the deposition of the tau protein deposited. The symptoms are extremely similar, but looking at the pathology allows you to make a different diagnosis between the two diseases. Sometimes, there can even be examples of symptoms of Parkinson’s disease―like what Muhammad Ali had. Even more, there can be conditions also similar to amyotrophic lateral sclerosis (ALS), otherwise known as Lou Gehrig’s disease. In fact, some in the medicine community think that Lou Gehrig may not have actually had Lou Gehrig’s disease, and in fact may have had CTE.
Is there a way to control CTE and its progressive and degenerative nature?
Unfortunately, no. Not yet anyway. There is much research to be done. As of now, CTE is being treated in the same way as Alzheimer’s. The problem is, CTE can’t be diagnosed before death. This makes it extremely difficult to perform testing―for now. Future of biomarkers and brain scans may be able to detect early evidence of CTE in the coming years.
Is there anything that you have come across during research that was particularly eye-opening? Maybe something that you would consider a breakthrough that you’ve come across that others have not?
The biggest thing that caught my eye while conducting my research is the significant differences between genders, and how they are affected by head trauma. Women receive concussions from head collisions much easier and more often than men. Female athletes, even in the same sport as male athletes, express more concussion related symptoms, and especially migraine-like symptoms. When that index is high, females usually take longer to recover. I actually presented these findings through XLNTbrain at the American Academy of Neurology Sports Concussion Conference this past summer.
What is the the most dangerous myth about concussions that the general population may believe?
I think the worst one is that people think you have to have lost consciousness to have a received a concussion. But in fact, only 10% of concussion injuries result in a loss of consciousness. That is potentially dangerous rhetoric as many people may not receive treatment, and potentially go undiagnosed.
I’m interested in your free concussion testing app, XLNTbrain Mobile. It seems like a great way to take your research and utilize it to safeguard the general public, and having it be mobile is an easy way to make sure that the general population can have access to it. But how effective is it at detecting that you actually have a concussion?
It’s not a replacement for going to to a physician. Nothing is. You can’t just use the app to determine whether or not you have a concussion or not. However, it helps you organize an approach to assessing a potentially injured athlete on the sideline. So often, there are no medical professionals in the lower levels of athletics waiting on the sideline to help an athlete. And then the physicians don’t have an immediate knowledge of the occurrence. Medical providers can look at the report in the app for symptoms which the athlete may not be able to explain because, well, they were concussed. The app also has a notification process which can alert people involved in care for the athlete, whether it’s their doctor, coach, or parents.
I would be remiss if I didn’t ask you something pertaining to the film, CONCUSSION. How much, in your opinion, would you say that the NFL actually has a blockade on concussion research? My initial reaction would be to say that the league has way too much influence on the flow of information regarding its own player safety.
It’s all changing dramatically. It’s important to note the time period of the film, and the improvements made since then. Early on there was too much control, like you said, over the flow of information and influence. And there were many publications published at the time incorrectly saying that concussions were not a concern. The NFL had a lot of influence through the team and its doctors, as I mentioned earlier. For good scientific endeavor, you really need independence. Nowadays, there are steps being taken to not only develop a better understanding, but also to inform everyone involved about the potential risks. Informed consent. Because you want to go into anything with your eyes open. A good analogy would be that of Big Tobacco. Huge companies had massive influence on what we really knew about how smoking affected our health. Luckily that changed!
Do you feel as if Roger Goodell doesn’t care about concussion safety as much as he should?
No, I wouldn’t say that. I think he cares quite a bit. He has a huge weight on his shoulders―Certain inertia he has to deal with, that conflicts with the responsibilities of a running a successful league. The league has gotten better in recent years.
What are some pros and cons of a film such as CONCUSSION now being a part of everyday culture?
I think it is nearly all good, actually. It raises awareness and raises issue to public eye, and that’s great. If there was anything at all that could even be a con, it’s that parents may stop having their kids participate in organized football. And as I said earlier, youth athletics are extremely important.
Finally, on a lighter note―Do you have a favorite in the CFB Final? And who’s your pick for the Super Bowl?
I’m not a big Alabama fan as my daughter went to Auburn, but I can’t see Clemson taking them down. I’m going to have to go with Alabama. And the Super Bowl seems up in the air to me!
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