Skip to main content
SpringerLink
Log in

The Evidence for Chronic Traumatic Encephalopathy in Boxing

  • Leading Article
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

The sport of boxing has been the source of much debate, with concerns about the neurological risks of participating having led to many calls to ban the sport. This review seeks to establish an evidence base for the development of boxing-related chronic traumatic encephalopathy (CTE) and to determine the relevance of this information to the modern day sport.

The clinical features of CTE include various symptoms affecting the pyramidal and extrapyramidal systems, which manifest most often as disturbed gait and coordination, slurred speech and tremors, as well as cerebral dysfunction causing cognitive impairments and neurobehavioural disturbances. Both amateur and professional boxers are potentially at risk of developing CTE. No current epidemiological evidence exists to determine the prevalence of this condition in modern day boxing, despite 17% of professional boxers in Britain with careers in the 1930–50s having clinical evidence of CTE.

As medical presence within the sport increases and with modern boxers likely to have shorter careers, a reduced exposure to repetitive head trauma, and improved treatment and understanding of the development of CTE will occur. This should lead to the incidence of CTE diminishing in boxing populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Martland H. Punch drunk. JAMA 1928; 91: 1103–7

    Article  Google Scholar 

  2. Millspaugh J. Dementia pugilistica. US Naval Medical Bulletin 1937; 35: 297–303

    Google Scholar 

  3. Parker H. Traumatic encephalopathy of professional pugilists. J Neurol Psychopathol 1934; 15: 20–8

    Article  PubMed  CAS  Google Scholar 

  4. Critchley E. Nervous disorders in boxers. Medical Annual 1937: 318–20

    Google Scholar 

  5. Clausen M, Anderson V, McCrory P. The risk of chronic traumatic brain injury in professional boxing: change in exposure variables in professional boxing over the past century. Br J Sports Med 2005; 39: 661–5

    Article  PubMed  CAS  Google Scholar 

  6. Guterman A, Smith R. Neurological sequelae of boxing. Sports Med 1987; 4: 194–210

    Article  PubMed  CAS  Google Scholar 

  7. Jordan B. Chronic traumatic brain injury associated with boxing. Serrun Nemol 2000; 20 (2): 179–85

    CAS  Google Scholar 

  8. Roberts A. Brain damage in boxers: a study of prevalence of traumatic encephalopathy among ex-professional boxers. London: Pitman Medical Scientific Publishing Co., 1969

    Google Scholar 

  9. Jordan B, editor. Medical aspects of boxing. Boca Raton (FL): CRC Press, 1993

    Google Scholar 

  10. LaCava G. Boxer’s encephalopathy. J Sports Med 1963; 3: 87–92

    Google Scholar 

  11. Cantu R, editor. Boxing and medicine. Champaign (IL): Human Kinetics, 1995

    Google Scholar 

  12. Johnson J. Organic psychosyndromes due to boxing. Br J Psychiatry 1969; 115: 45–53

    Article  PubMed  CAS  Google Scholar 

  13. Jordan B. Neurologic aspects of boxing. Arch Neurol 1987; 44: 453–9

    Article  PubMed  CAS  Google Scholar 

  14. Jordan B. Boxing. In: Jordan B, Tsaris P, Warren R, editors. Sports neurology. 2nd ed. Philadelphia (PA): Lippincott-Raven, 1998: 351–67

    Google Scholar 

  15. Corsellis J, Bruton C, Freeman-Browne D. The aftermath of boxing. Psychol Med 1973; 3: 270–303

    Article  PubMed  CAS  Google Scholar 

  16. Payne E. Brains of boxers. Neurochirurgia (Stuttg) 1968; 11 (5): 173–89

    CAS  Google Scholar 

  17. Corsellis J. Boxing and the brain. Br Med J 1989; 298 (6666): 105–9

    Article  CAS  Google Scholar 

  18. Brandenberg W, Hallevorden J. Dementia pugifistica unit anatonnischem Befund. Virchows Arch Tatbot Anat Physiol Klin Med 1954; 325: 680–709

    Google Scholar 

  19. Neubuerger K, Simon D, Denst J. Cerebral atrophy associated with boxing. Arch Nemol Psychiatry 1959; 81: 403–8

    Article  CAS  Google Scholar 

  20. Grahmann H, Ule G. Beitrag zur Kenntnis der chronischen cerebralen Krankheitsbilder bei Boxern. Psychiatr Neurol (Basel) 1957; 134: 261–83

    Article  CAS  Google Scholar 

  21. Constantinedes J, Tissot R. Lesions neurofibrillaires d’Alzhiemer genealisees sans plaques senils. Schweiz Arch Neurol Neurochir Psychiatr 1967; 100: 117–30

    Google Scholar 

  22. Carroll E. Punch drunk. Am J Med Sci 1936; 191: 706–12

    Google Scholar 

  23. Critchley M. Medical aspects of boxing, particularly from a neurological standpoint. Br Med J 1957; 51 (5015): 357–62

    Article  Google Scholar 

  24. Winterskin C. Head injuries attributable to boxing. Lancet 1937; 11: 719–20

    Article  Google Scholar 

  25. Unterharnscheidt F. A neurologist’s reflections on boxing. II: acute and chronic clinical findings secondary to central nervous system damage. Rev Neurol 1995; 23 (122): 833–46

    PubMed  CAS  Google Scholar 

  26. Casson I, Sham R, Campbell E, et al. Neurological and CT evaluation of knocked-out boxers. J Neurol Neurosurg Psychiatry 1982; 45: 170–4

    Article  PubMed  CAS  Google Scholar 

  27. Roberts G, Allsop D, Bruton C. The occult aftermath of boxing. J Neurol Neurosurg Psychiatry 1990; 53: 373–8

    Article  PubMed  CAS  Google Scholar 

  28. McAlpine D, Page F. Midbrain syndrome in a boxer. Proc R Soc Med 1949; 42: 792–3

    PubMed  CAS  Google Scholar 

  29. Kremer M, Russell W, Ge S. A mnidbrain syndrome following head injury. J Neurol Neurosurg Psychiatry 1947; 10: 49–60

    Article  PubMed  CAS  Google Scholar 

  30. Ross R, Casson I, Siegel O, et al. Boxing injuries: neurologic, radiologic, and neuropsychologic evaluation. Clin J Sport Med 1987; 6 (1): 41–51

    CAS  Google Scholar 

  31. Thomassen A, Juul-Jensen P, de Fine Olivarius B, et al. Neurological, electroencephalographic and neuropsychological examination of 52 former amateur boxers. Acta Nemol Scand 1979; 60 (6): 352–62

    Article  CAS  Google Scholar 

  32. Kaste M, Kumne T, Vilkki J, et al. Is chronic brain damage in boxing a hazard of the past? Lancet 1982; II (8309): 1186–8

    Article  Google Scholar 

  33. Ross R, Cole M, Thompson J, et al. Boxers: computed tomography, EEG and neurological evaluation. JAMA 1983; 249 (2): 211–3

    Article  PubMed  CAS  Google Scholar 

  34. Casson I, Siegel O, Sham R, et al. Brain damage in modern boxers. JAMA 1984; 251 (20): 2663–7

    Article  PubMed  CAS  Google Scholar 

  35. Brooks N, Kupshik G, Wilson L, et al. A neuropsychological study of active amateur boxers. J Neurol Neurosurg Psychiatry 1987; 50: 997–1000

    Article  PubMed  CAS  Google Scholar 

  36. Levin H, Lippold S, Goldman A, et al. Neurobehavioural functioning and magnetic resonance imaging findings in young boxers. J Neurosurg 1987; 67: 657–67

    Article  PubMed  CAS  Google Scholar 

  37. McLatchie G, Brooks N, Galbraith S, et al. Clinical neurological examination, neuropsychology, electroencephalography and computed monographic head scanning in active amateur boxers. J Neurol Neurosurg Psychiatry 1987; 50: 96–9

    Article  PubMed  CAS  Google Scholar 

  38. Jordan B, Zimmerman R. Magnetic resonance imaging in amateur boxers. Arch Nemol 1988; 45: 1207–8

    Article  CAS  Google Scholar 

  39. Haglund Y, Edman G, Murelius O, et al. Does Swedish amateur boxing lead to chronic brain damage? Part 1: a retrospective medical, neurological and personality trait study. Acta Neurol Scand 1990; 82: 245–52

    Article  PubMed  CAS  Google Scholar 

  40. Heilbronner R, Henry G, Carson-Brewer M. Neuropsychologic test performance in amateur boxers. Am J Sports Med 1991; 19 (4): 376–80

    Article  PubMed  CAS  Google Scholar 

  41. Holzgraefe M, Lemme W, Funke W, et al. The significance of diagnostic imaging in acute and chronic brain damage in boxing: a prospective study in amateur boxing using magnetic resonance imaging (MRI). But J Sports Med 1992; 13 (8): 616–20

    CAS  Google Scholar 

  42. Butler R, Forsythe W, Beverly D, et al. A prospective controlled investigation of the cognitive effects of amateur boxing. J Neurol Neurosurg Psychiatry 1993; 56: 1055–61

    Article  PubMed  CAS  Google Scholar 

  43. Stewart W, Gordon B, Selnes O, et al. Prospective study of central nervous system function in amateur boxers in the United States. Am J Epidermol 1994; 139 (5): 573–88

    CAS  Google Scholar 

  44. Kemp P, Houston A, Macleod M, et al. Cerebral perfusion and psychometric testing in military amateur boxers and controls. J Neurol Neurosurg Psychiatry 1995; 59: 368–74

    Article  PubMed  CAS  Google Scholar 

  45. Porter M, Tricker P. Controlled prospective neuropsychological assessment of active experienced amateur boxers. Chin J Sport Med 1996; 6 (2): 90–6

    Article  CAS  Google Scholar 

  46. Master E, Kessels A, Lezak M, et al. Acute traumatic brain injury in amateur boxing. Phys Sportsmed 2000; 28 (1): 87–92, 95-6

    Google Scholar 

  47. Porter M. A 9-year controlled prospective neuropsychologic assessment of amateur boxing. Clin J Sport Med 2003; 13 (6): 339–52

    Article  PubMed  Google Scholar 

  48. Sirom V, Scotti G, Ravagnati L, et al. CT-scan and EEG findings in professional pugilists: early detection of cerebral atrophy in young boxers. J Neurosurg Sci 1982; 26: 165–8

    Google Scholar 

  49. Jordan B, Matser E, Zimmerman R, et al. Sparring andcognitive function in professional boxers. Phys Sportsmed 1996; 24 (5): 87–98

    Article  PubMed  CAS  Google Scholar 

  50. Jordan B, Relkin N, Ravdin L, et al. Apolipoprokin E epsilon4 associated with chronic traumatic brain injury in boxing. JAMA 1997; 278 (2): 13640

    Article  Google Scholar 

  51. Ravdin L, Barr W, Jordan B, et al. Assessment of cognitive recovery following sports related head trauma in boxers. Clin J Sport Med 2003; 13 (1): 21–7

    Article  PubMed  Google Scholar 

  52. Serel M, Taros O. The mechanisms of cerebral concussion in boxing and their consequences. World Neurol 1962; 3: 351–8

    Google Scholar 

  53. Drew R, Templer D, Schuyler B, et al. Neuropsychological deficits in active licensed professional boxers. J Clin Psych 1986; 42: 520–5

    Article  CAS  Google Scholar 

  54. Murelms O, Haglund Y. Does Swedish amateur boxing lead to chronic brain damage? Part 4: a retrospective neuropsychological study. Acta Neurol Scand 1991; 83 (1): 9–13

    Article  Google Scholar 

  55. Spillane J. Five boxers. Br Med J 1962; 2: 1205–10

    Article  PubMed  CAS  Google Scholar 

  56. Isherwoorl I, Mawdsley C, Ferguson F. Pneumoencephalographic changes in boxers. Acta Radiol 1966; 5: 654–61

    Google Scholar 

  57. Mawdsley C, Ferguson F. Neurological disease in boxers. Lancet 1963; 282 (7312): 795–801

    Article  Google Scholar 

  58. Finke J, Koch G. Gas cavi septpellucidi. Dtsch Z Nervenheilkld 1968; 193: 1547

    Google Scholar 

  59. Bogdanoff B, Natter H. Incidence of cavum septum pellucidum in adults: a sign of boxer’s encephalopathy. Neurology 1989; 39: 991–2

    Article  PubMed  CAS  Google Scholar 

  60. Cabanis E, Perez G, Taneaz J, et al. Cephalic magnetic resonance imaging of boxers: preliminary results. Acta Radiol 1986; 369 (Suppl.): 365–6

    CAS  Google Scholar 

  61. MacPherson P, Teasdale E. CT demonstration of a 5th ventricle: a finding to KO boxers? Neuroradiology 1988; 30: 506–10

    Article  PubMed  CAS  Google Scholar 

  62. Jordan B, Zimmerman R. Computed tomography and magnetic resonance imaging comparisons in boxers. JAMA 1990; 263 (12): 16704

    Article  Google Scholar 

  63. Haglund Y, Persson H. Does Swedish amateur boxing lead to chronic brain damage? Part 3: a retrospective clinical neurophysiological study. Acta Neurol Scand 1990; 82 (6): 353–60

    Article  PubMed  CAS  Google Scholar 

  64. Jordan B, Jahre C, Hauser W, et al. CT of 338 active professional boxers. Neuroradiology 1992; 185: 509–12

    CAS  Google Scholar 

  65. Harvey P, Davis J. Traumatic encephalopathy in a young boxer. Lancet 1974; 304 (7556): 928–9

    Article  Google Scholar 

  66. McCrory P. Cavum septi pellucidi: a reason to ban boxers? Br J Sports Med 2002; 36: 157–61

    Article  PubMed  CAS  Google Scholar 

  67. Moseley I. The neuroimaging evidence for chronic brain dorm age due to boxing. Neuroradiology 2000; 42: 1–8

    Article  PubMed  CAS  Google Scholar 

  68. Jordan B, Jahre C, Hauser W, et al. Serial computed tomography in professional boxers. J Neuroimag 1992; 2: 181–5

    Google Scholar 

  69. Haglund Y, Bergstrand G. Does Swedishamateur boxing lead to chronic brain damage? Part 2: a retrospective study with CT and MRI. Acta Neurol Scand 1990; 82 (5): 297–302

    Article  PubMed  CAS  Google Scholar 

  70. Davie C, Pirtosek Z, Barker G, et al. Magnetic resonance spectroscopic study of parkinsonism related to boxing. J Neurol Neurosurg Psychiatry 1995; 58: 688–91

    Article  PubMed  CAS  Google Scholar 

  71. Chaudhuri K, Lemmens G, Williams S, et al. Magnetic resonance spectroscopic study of parkinsonism related to boxing (matters arising) petterl. J Neurol Neurosurg Psychiatry 1995; 59 (5): 561–2

    Article  PubMed  CAS  Google Scholar 

  72. Rodriguez G, Ferrillo F, Montano V, et al. Regional cerebral blood flow in boxers petted. Lancet 1983; 322 (8354): 858

    Article  Google Scholar 

  73. Kemp PM, Houston AS, Macleod MA, et al. Cerebral perfusion and psychometric testing in military amateur boxers and conhols. J Neurol Neuroserg Psychiatry 1995; 59: 368–74

    Article  CAS  Google Scholar 

  74. Houston A, Kemp P, Macleod M, et al. Use of significance image to determine patterns of cortical blood flow abnormality in pathological and at-risk groups. J Nucl Med 1998; 39: 425–30

    PubMed  CAS  Google Scholar 

  75. Busse E, Silverman A. Electroencephalographic changes in professional boxers. JAMA 1952; 149 (17): 1522–5

    Article  CAS  Google Scholar 

  76. Brookler K, Itil T, Jordan B. Elecho-physiologic testing in boxers. In: Jordan B, editor. Medical aspects of boxing. Boca Raton (FL): CRC Press, 1993: 207–14

    Google Scholar 

  77. Kaplan H, Browder J. Observations on the clinical and brain wave patterns of professional boxers. JAMA 1954; 156 (12): 1138–44

    Article  CAS  Google Scholar 

  78. Larsson L, Melin K, Nordstrom-Ohrberg G, et al. Acute head injuries in boxers: clinical and elechoencephalographic studies. Acta Psychiah Neurol Scand 1954; 95 (Suppl.): 142

    Google Scholar 

  79. Blonstein J, Clarke E. Further observations on the medical aspects of amateur boxing. Br Med J 1957; 1: 362–4

    Article  PubMed  CAS  Google Scholar 

  80. Breton F, Pincemaille Y, Taniere C, et al. Event-related potential assessment of attention and the orienting reaction in boxers before and after a fight. Biol Psychol 1990; 31 (1): 57–71

    Article  Google Scholar 

  81. Suntan M. Auditory brain stem responses of knocked-out boxers. No To Shinkei 1988; 40 (9): 883–7

    Google Scholar 

  82. Brayne C, Dow L, Calloway S, et al. Blood creatine kinase iscenzyme BB in boxers. Lancet 1982; II: 1308–9

    Article  Google Scholar 

  83. Horner E, Lee T, Tipton K, et al. Creatine kinase and neuronspecific enolase: serum markers of cell damage in the central nervous system in boxers. Cfin J Sport Med 1993; 3 (3): 144–8

    Article  Google Scholar 

  84. Haglund Y, Eriksson E. Does amateur boxing lead to chronic brain damage? A review of some recent investigations. Am J Sports Med 1993; 21 (1): 97–109

    Article  PubMed  CAS  Google Scholar 

  85. Kemp P. A critique of published studies into the effects of amateur boxing: why is there a lack of consensus? J R Nav Med Serv 1995; 81 (winter): 182–9

    PubMed  CAS  Google Scholar 

  86. Unterhamscheidt F, Sellier K. Vom Boxen: 1. Mitteilung: mechanik der traumatischen Schaden des ZNS bei Boxern. Med Sport (Berl) 1970; 10: 35–45

    Google Scholar 

  87. Unterhamscheidt F, Sellier K. Vom Boxen: 2. Mitteilung: pathomorphologie and Klinik der haumafischen Schaden des ZNS bei Boxern. Med Sport (Berl) 1970; 10: 111–7

    Google Scholar 

  88. National Health and Medical Research Council. Boxing injuries. Canberra (ACT): Australian Government Publishing Service, 1994

    Google Scholar 

  89. Unterhamscheidt F. About boxing: review of historical and medical aspects. Tex Rep Biel Med 1970; 28 (4): 421–95

    Google Scholar 

  90. Omuta B, DeKosky S, Minster R, et al. Chronic traumatic encephalopathy in a national football league player. Neurosurgery 2005; 57 (1): 128–34

    Article  Google Scholar 

  91. McCrory P. Boxing medicine: the 40-year view of a master in the field. SportHealth 2004; 22 (1): 21–2

    Google Scholar 

  92. McCrory P. Punch drunk: too many hits or bad genes? SportHealth 2002; 20 (5): 23

    Google Scholar 

Download references

Acknowledgements

Paul McCrory is supported by a National Health and Medical Research Career Development Grant. Tsharni Zazryn is supported by a National Health and Medical Research Council PhD Scholarship. The authors have no conflicts of interest that are directly relevant to the content of this article.

Author information

Authors and Affiliations

  1. Centre for Health, Exercise and Sports Medicine and the Brain Research Institute, University of Melbourne, Melbourne, Victoria, Australia

    Paul McCrory

  2. Department of Health Science, School of Primary Health Care, Monash University, McMahons Road, Frankston, Victoria, 3199, Australia

    Tsharni Zazryn

  3. Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia

    Peter Cameron

Authors
  1. Paul McCrory
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tsharni Zazryn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Cameron
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tsharni Zazryn.

Rights and permissions

Reprints and permissions

About this article

Cite this article

McCrory, P., Zazryn, T. & Cameron, P. The Evidence for Chronic Traumatic Encephalopathy in Boxing. Sports Med 37, 467–476 (2007). https://doi.org/10.2165/00007256-200737060-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00007256-200737060-00001

Keywords

Search

Navigation