In Reply

Boxing—Acute Complications and Late Sequelae: From Concussion to Dementia by Prof. Dr. med. Hans Förstl, Prof. Dr. rer. nat. Christian Haass, Prof. Dr. med. Bernhard Hemmer, Prof. Dr. med. Bernhard Meyer, Prof. Dr. med. Martin Halle in volume 47/2010

Lindemann rightly points out that we were conservative in our reporting of the serious risks associated with boxing and that other studies have reported higher rates of damage. The manuscript’s reviewers instructed us to adopt a conservative stance, and also we had restricted our study to relevant publications from the past 10 years. Since our article was accepted, some newer studies have been published that point out further risks:

• A lowering and delay of the cerebral attention potential (P300) (1)
• Sensory deficits (2)
• Extensive functional brain changes with hypometabolism in the area of the parietal lobe, posterior cingulate gyrus, frontal cortex, and cerebellum (the first three structures are also functionally and neuropathologically affected in Alzheimer’s disease (3).
• An increased risk of Parkinson’s disease with an increasing number of fights (study in Thai boxers) (4).

Löllgen and Prange mention ethical problems, which arise from knowing about the fundamentally increased risk (intentional brain injury), particular risk factors (APOE 4 and the destruction markers NSE and S100B), and potential protective measures (such as genotyping, head protection, prohibition of fights, etc). Basically, the following questions need to be addressed:

• What is the justification for granting intentional bodily harm an exemption from legal prosecution and for presenting it as a form of exemplary sportsmanship?
• Whether public broadcasters actually fulfill their remit by broadcasting programs that glorify violence
• Whether the costs should be borne by television-fee payers and by the solidarity based community of people with health and care insurance
• Why medical associations in Germany have thus far not taken position vis-à-vis boxing.

The reaction to our article was not unanimously positive. A former professional boxer, for example, pointed out the specific relevance of specific comorbidities in professional boxing that we had not included in our article (alcohol and drug addiction, promiscuity related problems; ZDF.deSport, “Boxen macht Boxern kein Kopfweh [Boxing does not cause boxers a headache]”).

DOI: 10.3238/arztebl.2011.0146

Prof. Dr. rer. nat. Christian Haass*

Prof. Dr. med. Bernhard Hemmer

Prof. Dr. med. Bernhard Meyer

Prof. Dr. med. Martin Halle

Technische Universität und
*Deutsches Zentrum Neurodegenerative Erkrankungen, München

Prof. Dr. med. Hans Förstl

Klinik und Poliklinik für Psychiatrie und Psychotherapie

Technische Universität München

Ismaningerstr. 22, 81675 München, Germany

Conflict of interest statement
Professor Förstl has received financial support from Eisai, General Electric Lundbeck Pfizer, Merz Janssen, AstraZeneca, BMS, GSK, Lilly, Nutricia, Sanofi Aventis, Schwabe, Servier, and others.

Professors Haass, Hemmer, Meyer, and Halle declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.

References

1. Di Russo F, Spinelli D: Sport is not always healthy: executive brain dysfunction in professional boxers. Psychophysiology 2010; 47: 425–34.

2. Vent J, Koenig J, Hellmich M, et al.: Impact of recurrent head trauma on olfactory function in boxers: a matched pairs analysis. Brain Res 2010; 1320: 1–6.

3. Provenzano FA, Joran B, Tikofsky RS, et al.: F-18FDG-PET-imaging of chronic traumatic bain injury in boxers: a statistical parametric analysis. Nuclear Med Comm 2010; 31: 952–7.

4. Lolekha P, Phanthumchinda K, Bhidayasari R: Prevalence and risk factors of Parkinson’s disease in retired Thai traditional boxers. Movement Disorders 2010; 12: 1895–901.

5. Förstl H, Haass C, Hemmer B, Meyer B, Halle M: Boxing: acute complications and late sequelae, from concussion to dementia. Dtsch Arztebl Int 2010; 107(47): 835–9.