SC shooting suspect, former NFL player Phillip Adams will undergo CTE brain test
ROCK HILL, S.C. (The Charlotte Observer) - Former NFL player Phillip Adams, who died after being identified as the suspect in a mass shooting in Rock Hill, S.C., will have his brain tested for CTE as part of the autopsy procedures, per the York County Coroner.
Adams, sheriff’s office officials have said, fired as many as 20 shots Wednesday and is accused of forcing his way into the home of prominent Rock Hill doctor Robert Lesslie. Five people, including two children, were killed and a sixth person was injured in the shooting. Authorities say Adams died by suicide later.
Sabrina Gast, York County Coroner, said that she spoke with the Adams family for approval to have the procedure done. The Medical University of South Carolina Charleston will be performing the autopsy, Gast said. The coroner’s office will be working with Boston University on the CTE study.
It’s expected to take months before the results of the testing are available, with one estimate of anywhere from three-to-six months.
Chronic Traumatic Encephalopathy (CTE) is defined by the Boston University CTE Center as “a degenerative brain disease found in athletes, military veterans, and others with a history of repetitive brain trauma.” It has been seen in people as young as 17, however, symptoms do not typically appear until years after head impacts begin.
It is not known at this time where Adams shot himself. If he shot himself in the head, the brain can still be tested for CTE, but it makes it more complicated. The type of weapon used and the nature of the injury are among the factors that can impact the condition of the brain.
CTE DIAGNOSIS REQUIRES SPECIALTY TESTS
Adams, 32 played in the NFL for six years after a four-year college career at S.C. State. His father, Alonzo Adams, told WCNC in a interview, “I think the football messed him up.”
Despite that, it can not be concluded until the tests are done whether or not he actually had CTE.
Doctors with a specialty in brain diseases will perform a variety of tests on the brain, not just look for CTE, to have a full knowledge of any other diseases or complications. To determine if CTE exists, doctors slice brain tissue and use special chemicals to make the abnormal tau protein visible. They then systematically search areas of the brain for tau in the pattern specific to CTE.
“You can have a suspicion that CTE may be there if somebody has a high exposure to repetitive head injuries like you would get from 10 or more years of playing football, and if the individual has cognitive and behavioral problems, and if those problems are progressive. Those problems cannot be explained by some other brain disease,” Dr. Robert Cantu, Concussion Legacy Foundation medical director and a co-founder of the BU CTE Center, told The Observer.
“Nobody can say whether he has or doesn’t have CTE,” Cantu said. “But the clearer question in some ways, is even if he does have low-grade CTE, was that the major cause of what he did?”
Cantu pointed out the “overwhelming majority” of people who act violently likely do not behave that way because of CTE, and that the overwhelming majority who are later diagnosed with CTE have not been the suspects in mass shootings.
There may never be a direct answer as to what role CTE played or what else led to the shooting.
“So often, in these situations, there are other circumstances involved, (like) what problems (are) going on with the life after the high profile NFL (career), but often, substance abuse and so on,” Dr. Cantu said.
“It’s important for when the autopsy comes out, to see whether there were any symptoms in system that could have clouded his judgment, but I don’t think we’ll ever have a certain answer to what role (the disease had), if CTE is ultimately found.”
CTE HAS STAGES
Dr. Ann McKee, a neuropathologist at the Boston University CTE Center, who has played a key role in researching the disease, established the McKee CTE staging scheme to define severity in CTE. There are four stages to the illness. The minor levels are stages one and two and severe is stages three and four. The minor levels are more prevalent among younger patients.
“More often than not, it’s going to be (a) stage one or stage two disease,” Dr. Cantu said.
“In stage one, there have been a number of individuals that are at that stage, and actually had no symptoms whatsoever. There’s a wide range of severity of CTE, and in the mild there may be minimal or no symptoms. In the severe stages like (former Patriots tight end Aaron) Hernandez had, they are virtually all symptomatic.”
Dr. Kevin Bieniek from UT Health San Antonio, who has studied a variety of cases of CTE pointed out, however, that just because a patient is younger, that doesn’t always mean they will have a less severe case. There’s not a one-size fits all.
“There’s really no magic formula for who’s going to get this and who’s not,” Bieniek said. “But it’s a disease that’s linked to repetitive trauma that can come in a number of different shapes and forms.”
Behavior in younger and older patients of CTE can differ, as well.
“It’s hard to pinpoint, but I think generally younger people do have very pronounced behavioral features of this disease,” Bieniek said. “Where older individuals, a lot of other pathologies and a lot of other dementia-like aspects of this disease (may exist).”
Typically there is a delay of several decades after finishing the sport or what is causing repetitive hits to the head before CTE symptoms appear. Sometimes symptoms can appear while people are still in their 30′s and 40′s, but it is not the average case.
During the 2012 season with the Oakland Raiders, Adams suffered two concussions over a three-game stretch, which, combined with a groin injury, eventually ended his season. However, the number of concussions a person has is not the sole or even predominant factor of whether the person will develop CTE.
“Concussions count, and unquestionably we’re probably going to find they count more than one sub-concussive blow, but you can’t correlate concussions with your risk of CTE. (It’s) the total brain trauma that somebody takes,” Cantu said. “If you’ve played 14 or more years of a high impact sport like football, your risk of CTE is significantly higher tenfold than if you play, not at all or you played under four years. It’s correlated with what we refer to as a dose response, similar to years of smoking packs of cigarettes, your risk of lung cancer (goes up).”
The Boston University CTE Center has been the leader in researching the disease. The Center has been involved in studying a number of former NFL players’ brains, including results released in 2017 that showed 110 of 111 deceased NFL players studied had CTE.
The CTE testing is not normally part of an autopsy in York County, Gast said.
Gast has been coroner since 2008. This is the first CTE research package she has ordered as coroner. But in this case, where there have been reports of previous brain concerns, Gast said she believed the CTE testing is appropriate.
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