- The Washington Times - Wednesday, February 4, 2009

Dr. John Stiller read with interest a New York Times report last week about a sixth former NFL player who died under age 50 and suffered from brain damage normally associated with boxers.

The report, published during the hoopla leading up to the Super Bowl, casts a shadow over a sport confronted with growing medical evidence that its players face significant risk of developing brain damage.

Does that mean Pittsburgh Steelers quarterback Ben Roethlisberger, who suffered a concussion this season, won’t remember his name when he is 60? Or will he be one of the lucky ones who manages to take hits over a long career and not suffer a diminished mental capacity when he is a grandfather?

That is a big part of the problem here: Who is at risk and who is not?

Stiller and the Maryland State Athletic Commission soon may have the answers to that question with a study of boxers that could have far-reaching implications for all contact sports.

The Maryland commission and Stiller, its chief physician, have come up with a test to determine whether boxers are developing symptoms that could be an indicator of more-serious brain disorders as they age.

“We are talking about how to limit the number of people who end up with chronic traumatic brain injury and who end up disabled,” said Stiller, the chief neurologist at St. Elizabeth’s Hospital in the District.

Any such study would have useful results not just for boxing but for a contact sport like football as well. The debate in football over the impact of concussions has left players uncertain of the risks they take when they return to the field after blows to the head.

“We are hopeful this study will have a significant impact on all athletes,” said Patrick Pannella, executive director of the Maryland State Athletic Commission. “Football is a physical game. Boxing is a physical game. I would say it could have a lot of value for football players, anyone who is subjecting themselves to concussions and other injuries. Getting hit in the head is a part of the game.”

The study came about after a meeting between Pannella and Stiller at an American Association of Professional Ringside Physicians Conference in 2001. Stiller talked to Pannella about his goal of learning more about the damage fighters suffer in the ring and helping to make the sport safer.

“He was looking to define ways to discover brain injuries in boxers and reduce the incidents of that occurrence,” Pannella said. “He was also a very knowledgeable boxing fan, and he wasn’t seeking to ban the sport and hurt opportunities for fighters to fight. He wanted to find a way to provide boxers knowledge.”

Pannella hired Stiller as a neurologist for the Maryland commission, and they worked to develop a study that would have the cooperation of the fighters.

“The big stumbling block [Stiller] had was that boxers and trainers and managers normally don’t want to participate in tests that would prevent a boxer from fighting,” Pannella said. “He and I came up with the idea that we would conduct this study at boxing weigh-ins. There is down time, particularly at the club level, at boxing weigh-ins, where the fighters are waiting for the next test or the paperwork to be done or the medical examination, so this was the perfect time to do it.

“Then we had to convince the boxers it was OK,” he added. “So this is a voluntary study where boxers do not have to participate. When they do participate, they become anonymous. They are given a number, and the doctors who conduct the study cannot give any information to the commission.”

Any fighter who is licensed in Maryland must pass a neurological exam, so anyone who already had developed a problem that comes up in such tests would not be licensed. The study, though, is designed to discover visible indicators that show up before any symptoms do in standard neurological testing.

This study, which began in 2003 and so far has included nearly 250 fighters, is an effort to chronicle a boxer’s symptoms throughout his career, looking for changes from test to test.

Stiller hopes to have a paper completed soon on the preliminary findings. He also hopes to expand the study to convince other commissions to take part as well.

“It is a simple protocol and takes about 10 to 15 minutes in private,” Stiller said. “We gather some basic information, such as how much a fighter spars. Some of our data already shows that sparring is very important. We ask for an estimate on how often they spar, how many ground and to what degree to get a cumulative sparring index. Those with a high amount tend to do worse.”

Other tests include a smell identification test, a symbol digit modality test and a balance test.

“If we can go back and see if their smell was changing or some combination, we may be able to find a window to tell people, ‘Stop now and your chances of developing this [brain damage] will be small compared to if you keep going,’ ” Stiller said. “By the time you know you have it, it is too late.”

The NFL may find in Maryland the answers it needs about brain injuries - if the league really wants to know.

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