Parkinsonism Pugilistica /CTE my experience/journey by jackie

This is only my experience and journey and not a medical article although I will give resources that I find.

I am not a doctor or trained in the medical field or an expert. This is only my journey and if you think you have need medical advice suggest going to a doctor or medical facility!

We usual write about travel and life in SE Asia and sometimes write articles/post about health and medical here in SE Asia.

 I am writing sharing this because I think it is not just related to my experience.

In the America today lot of conversation about football players with head injuries.  Boxers for years have been called “punch drunk” after several years in the ring.  I would certainly think muay thai fighters could have the same symptoms.

I spent several years in Iraq during the war there as a contractor. I was not in the military but was able to travel the roads.  I had multiple IED/RPG concussions.    I am blessed that God gave me good health and mind and brought me home.  This is just a way for me to talk about it.  It might help someone else, but I am doing this more to help me.  Unless a person experience this, I find it hard to talk to a person about this. Usual you get a look like OK, I think you have to experience it to understand.

I have been away now for almost 4 years, the shaking/tremors in my hands started a year ago.  I understood what was happening but hid it. It was getting worse and harder to hide when I was in public.  It was not bad and is still not that bad but I see it when eating, drinking and sometimes with my camera.  Also when using the mouse on my mac.

 In May, my 5 years old daughter was on my lap and said papa “your hands are shaking” and she showed me.  That was the first time someone noticed!

I have other medical problem I associate with the concussions, detached retina but will just focus on the  Parkinsonism Pugilistica or also called Chronic Traumatic Encephalopathy

Updated Sept 15.2015    When researching this I used the tremors in my hands as the main symptom.  I have others but the easiest to understand are the tremors and to narrow the search, what came up was Parkinson Pugilistica.  Many of my symptoms are describe with Parkinson but not all!  Also doing more research I have found other symptoms or illness Chronic Traumatic Encephalopathyamyotrophic lateral sclerosis, and I have not used PTSD but that would also be seen in research.  I think a person that has had brain injury from concussions could get confused about what to call what they have, so maybe not able to ask for help or talk about with friends and family.  In my opinion, its all of them!  The pain, cramps in my legs, pain in my feet could not be described with Parkinson.   I suggest reading the pages on Chronic Traumatic Encephalopathy and amyotrophic lateral sclerosis for a better understanding!

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Military-related traumatic brain injury and neurodegeneration

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Below is taken from the NCBI and is technical but explains what happens. To read more of the article  can go to the LINK given

Mild traumatic brain injury (mTBI) includes concussion, sub-concussion, and most exposures to explosive blast from improvised explosive devices. mTBI is the most common traumatic brain injury affecting military personnel; however, it is the most difficult to diagnose and the least well understood. It is also recognized that some mTBIs have persistent, and sometimes progressive, long-term debilitating effects. Increasing evidence suggests that a single traumatic brain injury can produce long-term gray and white matter atrophy, precipitate or accelerate age-related neurodegeneration, and increase the risk of developing Alzheimer’s disease, Parkinson’s disease, and motor neuron disease. In addition, repetitive mTBIs can provoke the development of a tauopathy, chronic traumatic encephalopathy. We found early changes of chronic traumatic encephalopathy in four young veterans of the Iraq and Afghanistan conflict who were exposed to explosive blast and in another young veteran who was repetitively concussed. Four of the five veterans with early-stage chronic traumatic encephalopathy were also diagnosed with posttraumatic stress disorder. Advanced chronic traumatic encephalopathy has been found in veterans who experienced repetitive neurotrauma while in service and in others who were accomplished athletes. Clinically, chronic traumatic encephalopathy is associated with behavioral changes, executive dysfunction, memory loss, and cognitive impairments that begin insidiously and progress slowly over decades. Pathologically, chronic traumatic encephalopathy produces atrophy of the frontal and temporal lobes, thalamus, and hypothalamus; septal abnormalities; and abnormal deposits of hyperphosphorylated tau as neurofibrillary tangles and disordered neurites throughout the brain. The incidence and prevalence of chronic traumatic encephalopathy and the genetic risk factors critical to its development are currently unknown. Chronic traumatic encephalopathy has clinical and pathological features that overlap with post concussion syndrome and post traumatic stress disorder, suggesting that the three disorders might share some biological underpinnings.

1. Introduction

In military settings, most traumatic brain injuries (TBIs) are mild TBIs (mTBIs). For U.S. forces deployed to Afghanistan and Iraq in Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND), blast exposure is the leading cause of mTBI, although service members are also susceptible to concussions [1]. Estimates of the prevalence of mTBI among returning service members range from 15.2% to 22.8%, affecting as many as 320,000 troops [14]. Despite their frequency, the acute and long-term effects of mTBI have been a relatively unexplored area of medical inquiry until very recently. Undoubtedly, the “invisible” nature of mTBI, notably the lack of any external physical evidence of damage to the head or brain, has been a major factor contributing to the impression of inconsequentiality. However, there is accumulating evidence that some individuals develop persistent cognitive and behavioral changes after mild neurotrauma. In addition, the relative contributions of physical injury or psychic stress to chronic sequelae after mTBI remain a matter of debate– a discussion that began during World War I regarding the basis for “shell shock,” and that continues today concerning the relative contributions of posttraumatic stress disorder (PTSD) and physical brain injury to persistent symptoms after mTBI.

The first large-scale evidence of military-related mTBI occurred in World War I (1914–1918) in association with the frequent use of high explosives in trench warfare. Service members who experienced high doses of explosive artillery fire sometimes developed shell shock or “commotio cerebri,” a mysterious condition characterized by headache, amnesia, inability to concentrate, difficulty sleeping, depression, and suicidality [57]. At the time, it was unclear whether shell shock was a maladaptive, psychiatric condition related to the stresses of combat or whether the condition was caused by physical injury to the brain. Despite the lack of any pathological studies on the brains of individuals diagnosed with shell shock, wartime committees entreated with the responsibility to inquire into the entity declared the disorder to have psychiatric origins [7].

Shortly thereafter, Harrison Martland, a New Jersey pathologist, drew attention to a symptom complex that affected professional boxers, “Punch Drunk,” a condition well known to boxing enthusiasts that appeared to result from repeated sublethal blows to the head [8]. Martland described unsteadiness of gait, mental confusion, and slowing of muscular movements occasionally combined with hesitancy in speech, tremors of the hands, and nodding of the head. Later, Winterstein summarized the psychiatric manifestations of approximately 50 professional boxers and noted impairment of intelligence, mental dullness, difficulty concentrating, paranoia, and garrulousness [9]. Johnson later added memory loss, dementia, rage reactions, and morbid jealousy to the clinical syndrome [10]. In the scattered, small case series of “dementia pugilistica” reported over the next half century, the condition was variously referred to as “traumatic progressive encephalopathy” and later as “chronic traumatic encephalopathy” (CTE) to highlight the chronic and progressive nature of the disorder [11,12]. In 1973, Corsellis, Bruton, and Freeman-Browne detailed the neuropathological findings found in the brains of 15 retired boxers and correlated the pathological findings with retrospective clinical symptoms [13]. The authors noted gross neuropatho-logical changes of cerebral atrophy, enlargement of the lateral and third ventricles, thinning of the corpus callosum, cavum septum pellucidum with fenestrations, and cerebellar scarring. General cell stains and Von Braunm€uhl’s silver stain were used to demonstrate neuronal loss in the cerebellar tonsils and substantia nigra, neurofibrillary degeneration of the substantia nigra and cerebral cortex, and senile plaques in approximately one quarter of the cases. The authors speculated that pathology in the limbic structures (such as the hippocampus, medial temporal lobe, and fornix) was responsible for impairments in learning and memory, that pathology in the substantia nigra accounted for the Parkinsonian features, and that pathology in the septal cortex for the abnormal rage reactions.

1.2. Chronic effects of TBI

1.2.1. Alzheimer’s disease, Parkinson’s disease, and amyotrophic lateral sclerosis

Moderate-to-severe TBI is associated with progressive atrophy of gray and white matter structures that may persist months to years after injury [58,59]. In addition, multiple studies support a link between single moderate-severe TBI and Alzheimer’s disease (AD) [60,61], Parkinson’s disease (PD) [62], and amyotrophic lateral sclerosis (ALS

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What is Parkinsonism Pugilistica?

In the 1920’s a pathologist named Harrison Martland described, in a classical article published in theJournal of the American Medical Association (JAMA), a syndrome that was associated with repeated head injury particularly within former boxers.  Many physicians and scientists followed this seminal report over the ensuing decades by better characterizing this syndrome, and importantly by clarifying that it can occur in anyone with repeated head trauma.  The most important finding was that it was not exclusive to boxers.  The potential symptoms included memory problems, behavioral issues, paranoia, and other features such as hallucinations.  In cases where the predominant symptoms were related to thinking or behavior, the term Dementia Pugilistica was used, although some people have coined the term “punch drunk” to describe the behavioral features.  Punch drunk was also a term used in Martland’s original description.  In cases where tremor, stiffness, slowness, walking problems, or balance issues dominated the clinical picture, the term Parkinsonism Pugilistica has been utilized.  The syndrome should however, not be confused with regular Parkinson’s disease, which is a slowly progressive neurodegenerative disorder associated with motor and non-motor symptoms.  Regular Parkinson’s disease, unlike Dementia and Parkinsonism Pugilistica, is responsive to dopaminergic therapies.

What you need to know about Parkinsonism Pugilistica: The Punch Drunk Syndrome

What is the difference between Parkinsonism Pugilistica and regular Parkinson’s disease?

Parkinsonism pugilistica is thought to occur as a result of repeated blows to the head, and in some cases can result from multiple bad concussions.  Most cases of the syndrome have been referred to in the scientific literature as Dementia Pugilistica.  It is somewhat rare to observe the classical parkinsonian features of regular Parkinson’s disease associated with this head trauma related syndrome.  It is possible however, to observe some overlap symptoms (tremor, stiffness, slowness, walking issues) with the behavioral features.  The pattern and temporal occurrence of cognitive problems, and also the poor response to dopaminergic therapy can help one to distinguish Parkinsonism Pugilistica from regular Parkinson’s disease.  One should not assume that just because a person was a past boxer that they suffer from Dementia or Parkinsonism Pugilistica, or both.

How are Parkinson’s disease and Parkinsonism Pugilistica related to head trauma?

There are a number of epidemiological studies that have linked Parkinson’s disease risk to a history of head trauma.  If you already suffer from Parkinson’s disease, you should not worry too much about these large association type studies, as the treatment is the same for regular Parkinson’s disease, with or without a history of head trauma.

Parkinsonism Pugilistica can result from repeated blows to the head, regardless of the source of the impacts; it does not only affect boxers.  Recently, much press has been given to former NFL players, especially those with repeated head trauma, and coincident symptoms of Dementia and Parkinsonism Pugilistica.  Athletes from other sports, such as hockey, have also shown signs of Dementia and Parkinsonism Pugilistica.  It is important to keep in mind that in some cases have not been due to Dementia or Parkinsonism Pugilistica despite similar symptoms. .

Next post will discuss more about symptoms and what I have experienced.


12 Comments on “Parkinsonism Pugilistica /CTE my experience/journey by jackie

  1. Pingback: I was close today: Chronic traumatic encephalopathy (CTE)/PTSD  my journey by jackie | LIFE SE ASIA MAGAZINE

  2. Children notice everything!
    You’re amazingly positive under difficult circumstances and agree with pakdavebali – very brave. I hope that this doesn’t stop you from doing the things that you most love in life. Were you an IED Tech in Iraq?

    Liked by 1 person

  3. Pingback: Amyotrophic lateral sclerosis part of the series My Journey by jackie | LIFE SE ASIA MAGAZINE

  4. Pingback: Chronic traumatic encephalopathy (CTE) part of my journey by jackie | LIFE SE ASIA MAGAZINE

  5. Pingback: Parkinsonism Pugilistica my experience/journey part 2 by jackie | LIFE SE ASIA MAGAZINE

  6. We all have our cross to bear Jackie. I find that writing, particularly, poetry is a wonderful outlet to be able to express emotions and how I feel about myself in a particular time. I write for myself so I know that most readers will not understand, fully, the inner meaning within the words. It seems that, maybe, you needed to get this out, as a kind of release for you. I can empathise with you and admire you for taking a head-on’ approach which may well help others. Keep your pecker up. James

    Liked by 1 person

  7. Very brave to write this article. It will also help others who have not yet figured out what they are experiencing. I urge you to distribute it among vet blogs. I have a lot of respect for you and your Life in SE Asia Magazine.

    Liked by 1 person

  8. So sorry you have to go through this… My grandfather had Parkinson, so I know how had it’s to deal with such symptoms. I wish you a lot of health! Take care!

    Liked by 1 person

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