Can ALS be caused by traumatic brain injury?

Amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) is a neurologic disease that damages nerve cells in the spinal cord and brain, causing widespread muscle wasting and weakness. It strikes without warning, usually beginning between the ages of 55 and 75. As it worsens, ALS disables a person’s ability to move, speak, eat, or breathe. Although two FDA-approved medications can modestly slow its progress, death generally occurs within three to five years of diagnosis.

Decades of research have failed to come up with a definite cause. However, one new study supports a link between playing professional football and ALS.

Why is ALS called Lou Gehrig’s disease?

Since it was first described in the 19th century, much about ALS has remained mysterious. It’s quite rare, affecting about two in 100,000 people. It might have remained a disease you’d never heard of if not for Lou Gehrig, the Hall-of-Fame baseball player who played for the New York Yankees in the 1920s and 1930s. He developed ALS at age 36 and died of the disease two years later. Since then, ALS has often been called Lou Gehrig’s disease.

In recent years, widespread social media campaigns, such as the Ice Bucket Challenge, have raised awareness and funding for ALS research.

Searching for a cause of ALS

Some research suggests that risk factors for ALS include:

New research links playing professional football with ALS

A new study published in JAMA Network Open might help us better understand the cause of at least some cases of ALS. It strongly suggests that playing professional football may be a risk factor for the disease.

  • Between 1960 and 2019, 19,423 men played in the National Football League (NFL). During that time period, 38 were diagnosed with ALS and 28 died of the disease.
  • Among these current and former football players, the risk of developing ALS and dying of the disease was nearly four times higher than that of men in the general population.
  • NFL players who developed ALS had a longer average football career (seven years) than those without the disease (4.5 years).
  • Many NFL players were in their mid-30s at the time of their ALS diagnosis. This is quite a bit younger than is typical for ALS.

Importantly, this study did not assess why there might be a relationship between ALS and playing professional football. The study authors speculate that traumatic brain injury might be to blame.

How certain are these findings?

This was an observational study. Observational research can identify a link between a possible risk factor (in this case, playing in the NFL) and a disease (ALS). However, it cannot prove that the risk factor caused the disease.

For studies like this, it’s always possible that a confounder — a factor not studied or accounted for — might explain the connection. For example, this study did not collect information about head injuries, pesticide exposure, smoking, or family history. This means it can’t provide insight into whether these factors played a role in ALS risk.

In addition, the study identified diagnoses of ALS among NFL players only through Google News reports and obituaries. The diagnoses weren’t confirmed by a review of the players’ medical records. Therefore, cases of ALS could have been missed or misdiagnosed.

It’s also possible that the study missed cases of ALS among less famous players whose health news or deaths might be overlooked by the media. To account for this, the researchers logged indicators of NFL fame (including selection to the NFL Pro Bowl and Hall of Fame). They found no difference in ALS risk among more famous and less famous players.

The bottom line

Public health experts and researchers are trying to sort out which sports harm brain health, and to recommend ways to protect against brain injuries. Expert recommendations for contact sports have evolved to include protective equipment, changes in game rules, limiting participation by younger players, and discouraging participation after a head injury until recovery is complete.

As noted, studies have strongly linked brain injury from concussions and repetitive head injuries. This latest study suggests some cases of ALS may also be caused by brain trauma.

Lou Gehrig reportedly had multiple concussions over the course of his sports career. Regardless of whether he actually had Lou Gehrig’s disease or CTE with features of ALS, this new research raises the possibility that his demise might have been due to traumatic brain injury. And that should serve as a reminder that even as we cheer on those with inspiring athletic talent and win-at-all-cost determination, protecting the health of sports participants should be even more important.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

2 Corinthians 13:9 For we rejoice when we ourselves are weak but you are strong; this we also pray for, that you be made complete.

Colossians 1:28 We proclaim Him, admonishing every man and teaching every man with all wisdom, so that we may present every man complete in Christ.

Colossians 4:12 Epaphras, who is one of your number, a bondslave of Jesus Christ, sends you his greetings, always laboring earnestly for you in his prayers, that you may stand perfect and fully assured in all the will of God.

2 Corinthians 10:15-16 not boasting beyond our measure, that is, in other men’s labors, but with the hope that as your faith grows, we will be, within our sphere, enlarged even more by you, so as to preach the gospel even to the regions beyond you, and not to boast in what has been accomplished in the sphere of another.

2 Thessalonians 1:3 We ought always to give thanks to God for you, brethren, as is only fitting, because your faith is greatly enlarged, and the love of each one of you toward one another grows ever greater;

2 Peter 3:18 but grow in the grace and knowledge of our Lord and Savior Jesus Christ To Him be the glory, both now and to the day of eternity. Amen.

Ephesians 1:17-18 that the God of our Lord Jesus Christ, the Father of glory, may give to you a spirit of wisdom and of revelation in the knowledge of Him. I pray that the eyes of your heart may be enlightened so that you will know what is the hope of His calling, what are the riches of the glory of His inheritance in the saints,

Ephesians 3:16-19 that He would grant you, according to the riches of His glory, to be strengthened with power through His Spirit in the inner man, so that Christ may dwell in your hearts through faith; and that you, being rooted and grounded in love, may be able to comprehend with all the saints what is the breadth and length and height and depth, read more

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