Ali Fights a New Round

By Peter Stoler

A brain disorder focuses attention on the dangers of boxing

He could "float like a butterfly, sting like a bee." The young Muhammad Ali dazzled all who saw him perform in the ring, where his dancer's footwork and lightning-fast combinations enabled him to win the world heavyweight championship three times. And out of the ring, his nonstop chatter, his doggerel verse and his insistence that he was "the greatest" won him worldwide affection.

But the Ali who checked into the Neurological Institute at New York City's Columbia-Presbyterian Medical Center last week evoked a much different emotion. For at least two years, journalists and associates had noticed that Ali appeared to have aged beyond his years: his hand-eye coordination seemed to be impaired, and his speech was frequently unintelligible. The question was asked, aloud and in print: Could Ali, 42, who retired from boxing almost three years ago, be suffering from some kind of brain disorder?

After Ali checked into the hospital to complete tests, doctors provided an answer: he was suffering from symptoms similar to those of Parkinson's disease--slurred speech, loss of coordination, reduced muscle strength and a persistent of fatigue. The doctors' report raised the inevitable questions about whether Ali's problems were a product of his profession, and triggered anew the debate over whether boxing should be banned.

Ali's doctors said the former champion had been suffering from a Parkinson's-like syndrome since 1981, and they agreed with Ali that there might be a connection between his condition and his career, which began when he won an Olympic gold medal in Rome in 1960.

"I've been in the boxing ring for 30 years, and I've taken a lot of punches," a subdued Ali said at a news conference. "So there is a great possibility something could be wrong." But the doctors denied that Ali was suffering from dementia pugilistica, a medical term for the often caricatured condition of the simple-minded bruiser who has taken one punch too many. "He is not punch-drunk," said Dr. Stanley Fahn, the neurologist in charge of his case. Nor, doctors insisted, is Ali suffering from Parkinson's disease, a disorder that occurs when the brain ceases to produce sufficient amounts of dopamine, a substance that helps in the transmission of nerve impulses involved with motor control. Having some of the symptoms of the disease does not mean that he has the disease.

But Ali's condition could mean that he has suffered brain damage as a result of blows. A punch thrown by a heavyweight can land with a force exceeding 1,000 Ibs., and it can snap the head back or twist it violently, causing the jelly-like brain to be slammed against the rigid skull like a yolk inside a raw egg. When this happens, nerve cells and blood vessels may be twisted, ruptured or stretched. The brain, like any other damaged tissue, can swell, causing it to press against the inside of the skull, resulting in further damage.

Such brain injuries are not uncommon among boxers. An American doctor, Harrison Martland, observed as early as 1928 that boxers who took considerable punishment could become punch-drunk. Other physicians have documented the damage to fighters' brains. British Neurologist MacDonald Critchley reported in 1957 that a boxer's chances of suffering brain damage increased in direct proportion to the number of bouts fought. Another British researcher, Dr. J.A.N. Corsellis, reported in 1973 that he had examined the brains of 15 former fighters who had died of natural causes. Corsellis observed a striking pattern of cerebral changes rarely found in those who were not boxers. Subsequent studies have shown that boxers are far more likely than non-fighters to have a condition called cavum septi pellucidi--a cave, or space, between two membranes that divide the brain.

Many boxers with cavum septi pellucidi suffer permanently from the Parkinsonian symptoms that sent Ali to the hospital. After two days in the hospital, however, Fahn reported "that Ali was responding so well to doses of Sinemet and Symmetrel, drugs that replenish the brain's supply of dopamine, that his symptoms were "melting away." Visitors, including the Rev. Jesse Jackson, said that Ali was entertaining other patients with magic tricks and seemed to be his old ebullient self. Before leaving the hospital for a trip to the Sudan, Ali vowed to mend his ways. "I'll get all my business done by 10, get to sleep at 10:30 and sleep till 6," he declared.

The champion's improvement elated his admirers. Others pointed out that at least 70 fighters have died as a result of injuries over the past decade, and the issue was raised again last week of whether boxing should be allowed at all. British researchers have called for the abolition of the sport. In 1983 the American Medical Association carried an article in its journal stating that "the principal purpose of a boxing match is for one opponent to render the other injured, defenseless, incapacitated, unconscious . . . Boxing, as a throwback to uncivilized man, should not be sanctioned by any civilized society."

But the A.M.A. does not expect such a plea to be heeded. So the association has come up with 14 proposals that it is urging all states to adopt. Among them: requirements that fighters undergo rigorous physical and neurological examinations and that doctors with complete emergency equipment be present at ringside for all fights. New York State has adopted a program whose regulations correspond closely with those recommended by the A.M.A., and it has already used its new rules to disqualify at least two boxers with degenerative nerve disease. As Ali's experience shows, even the best boxers can take a beating to their bodies. Increasingly the view is that there is no reason why they should take it to their brains as well.

--By Peter Staler. Reported by Raji Samghabadi/New York

With reporting by Raji Samghabadi/New York