September 14, 2012

ALS in Football Players
By Alberto Ascherio, MD, DrPH, NEALS Member

In the most recent issue of Neurology¹, Lehman et al. reported a fourfold increase in ALS mortality in a cohort of 3,439 National Football League players.  The cohort comprised those players with at least 5 credited playing seasons between 1955 and 1988, and causes of death were ascertained between 1979 and 2007.  Although based on rather small numbers, the study is noteworthy because it adds to the evidence that repeated concussions may result in a progressive neurodegenerative disease that is clinically similar to ALS.  Most telling is the fact that the increase in ALS mortality was mostly found among “speed” players, among whom concussions are known to be more common.  An increased risk was also reported for dementia/Alzheimer disease, and all neurodegenerative causes, a definition that included Parkinson disease.  Not unexpectedly, the overall mortality among these NFL players, highly selected for physical fitness, was only about half that of the general U.S. population.  An interesting question is whether concussions could contribute to explain the increased ALS risk reported among Italian soccer players² and in the U.S. military³. Future investigations would benefit from pathological assessment to distinguish ALS from chronic traumatic encephalopathy.  Meanwhile, this study should bring additional welcome attention to the urgent need of better protecting young athletes from brain injury.

1. Lehman - ** the Neurology NFL ref.

2. Chio, A., A. Calvo, et al. (2009). "ALS in Italian professional soccer players: The risk is still present and could be soccer-specific." Amyotroph Lateral Scler 10(4): 205-209.

3. Weisskopf, M. G., E. J. O'Reilly, et al. (2005). "Prospective study of military service and mortality from ALS." Neurology 64(1): 32-37.