Evidence for brain trauma following five two minute rounds in boxing

Objectives

Severe cerebral acute injuries, resulting in morbidity or fatality, are rare in boxing compared with other sports.1 The British Medical Association has campaigned for a complete ban on boxing because of alleged chronic traumatic brain injury.2 A recent epidemiological study has concluded that such evidence is weak.3 The aim of this unique study was to analyse whether punches to the head (PTH), sustained during a boxing event, resulted in cerebral damage as quantified by elevated levels of neurochemical markers of brain tissue damage compared with punches to the body (PTB). Systemic stress was quantified by measuring serum cortisol.

Methods

Sixteen amateur boxers were divided into two groups: PTH, (n = 8, mean±s.d., age: 17.6±5.3 years; height: 168.4±13; weight: 65.4±20.3; punches to the head: 35.5±18.4), PTB (n = 8, mean±s.d., age: 19.1±3.2 years; height: 169.6±7.5; weight: 68.5±15). The PTH group received punches to the head and body, while group PTB received only punches to the body. Blood samples were taken pre- and immediately post combat for analysis of S-100B, neurone specific enolase (NSE) and cortisol.

Results

Significant increases (P<0.05) in serum concentrations of S-100B (0.35±0.61 versus 0.54±0.73 μg/L) and NSE (19.7±14 versus 31.1±26.6 ng /mL) and cortisol (372.9±201.5 versus 755.8±93ng /mL) were encountered pre- and immediately post combat in the PTH group but not in the PTB group.

Conclusions

PTH in boxing are sufficient enough to cause biochemically discernible damage of brain tissue. The risk of having an intra-cerebral haemorrhage from a mild brain injury (MBI) is 38%, with 7% requiring neurosurgical intervention.4 The consequences of a MBI may be a transitory post-concussive syndrome.5 Traumatic stress states are a well known pathology and consist of a psychological reaction against the trauma.

Disclosures

The authors have nothing to declare. All research complied with the Declaration of Helsinki. Ethical approval was provided by the University Ethics Committee.