YOUNG boxers can suffer irreversible brain damage just a few years into their careers, and without any warning signs to indicate that it is time to leave the ring, doctors in London were told last week.
At a meeting of the British Neuropathological Society, British researchers described the case of a 23-year-old boxer who died in the ring from a sudden and massive brain haemorrhage. They found that his brain had some of the structural abnormalities seen in people suffering from Alzheimer鈥檚 disease and in many old ex-boxers. They believe this is the first report of this type of brain damage in a young person.
The young boxer鈥檚 death provided a rare opportunity to study the earliest changes in the brain that might be brought on by repeated blows to the head. 鈥淢ost boxers who die in the ring are examined by forensic specialists who identify the immediate cause of death 鈥� usually a large bleed into the brain,鈥� says Jennian Geddes, the neuropathologist at the Royal London Hospital who presented the case to the meeting. They do not tend to look in detail at the rest of the brain, she says.
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鈥淲e found signs of long-standing brain damage and because there was no evidence of any other disease when he was alive, we have to assume it must have been caused by repeated blows to the head,鈥� she says.
Elderly ex-boxers often suffer from slurred speech, disturbed balance and poor memory 鈥� a condition called the punch-drunk syndrome. At postmortem, their brains look very similar to those of people who have had Alzheimer鈥檚. 鈥淭ypically, their brains reveal a pattern of amyloid plaques and neurofibrillary tangles that looks virtually identical to what we see in Alzheimer鈥檚,鈥� says Geddes. Tangles are abnormal clumps of a protein known as tau, which accumulate inside cells. Plaques are lumps of amyloid protein outside cells.
The young boxer in this case had been fighting since he was 11, and as a professional for four years. Apart from being 鈥渟omewhat forgetful鈥�, there was nothing in his behaviour to suggest that he might have suffered any damage to his brain.
So Geddes was surprised when she discovered there were tangles in his brain. More puzzling still, the tangles were not in the places where she would expect to see them in older boxers 鈥� and nor were there any plaques. 鈥淭he tangles were wrapped around blood vessels at the base and sides of the brain, which is exactly where the brain would sustain the force of any blows to the head,鈥� explains Geddes. 鈥淭his picture is not typical of what we find in Alzheimer鈥檚 disease or retired boxers鈥� brains.鈥� Geddes thinks she may have found the earliest stage in a process that eventually leads to the extensive damage seen in punch-drunk boxers.
She also believes that in boxers a different pathological process is at work from that in Alzheimer鈥檚 patients. Repeated blows to the skull could damage nearby blood vessels. 鈥淪omething may be leaking from the damaged vessels which causes tangles to form,鈥� she says. Another possibility is that as the blood vessel is torn away from the surrounding brain tissue by the force of the blow, it causes a chemical reaction that triggers the development of tangles.
And in this case the tangles must have formed quickly rather than over the many decades it is believed to take for Alzheimer鈥檚 disease to develop. A detailed report of Geddes鈥檚 findings will appear in the February issue of Neuropathology and Applied Neurobiology.
Geddes believes her finding reinforces the argument against allowing children to box. 鈥淲e simply don鈥檛 know how quickly it takes for tangles to form,鈥� says Geddes. 鈥淎nd young boxers may show no outward signs of brain damage.鈥� This level of damage would not show on a brain scan, the usual method of monitoring professional boxers.
Last month, Geddes re-examined the brain of another young boxer who died eight years ago. This time, using new techniques for staining the tissue, she found exactly the same abnormalities as she had in the more recent case. This reinforces her belief that the damage is 鈥済enuinely attributable to boxing鈥�.
The British Boxing Board of Control has repeatedly argued that there is no scientific evidence that professional boxers who fight by the BBBC rules suffer any cumulative brain damage. 鈥淚 know there is research looking into the possibility of brain damage in young boxers, but I鈥檓 also aware that there is some scepticism among doctors about how it鈥檚 being carried out,鈥� says Simon Block, assistant general secretary of the BBBC. The board believes that restrictions on the number and length of rounds in a bout have made punch-drunk syndrome 鈥渁 thing of the past鈥�.
鈥淭hat鈥檚 nonsense,鈥� says Peter Harvey, a neurologist at the Royal Free Hospital in London and a fervent campaigner against boxing. 鈥淥ne can only say that brain damage has occurred once it鈥檚 there,鈥� he says. Harvey argues that it is impossible to say that boxing is safe below a certain threshold.
While it may be possible to stop brain damage getting any worse once it becomes apparent, these two cases show that the BBBC鈥檚 existing rules cannot prevent it altogether. 鈥淭his will blow the top off boxing,鈥� he says.