JOHN DOHERTY: ALS link to concussions not new

2010-08-21T20:30:00Z 2010-08-23T16:20:03Z JOHN DOHERTY: ALS link to concussions not newBy John Doherty Sports Medicine
August 21, 2010 8:30 pm  • 

Scientists at Boston University, in a study to be published next month in the Journal of Neuropathology and Experimental Neurology, examined the spinal cords of two former NFL players and one boxer who had been diagnosed with amyotrophic lateral sclerosis (ALS or Lou Gehrig's Disease) and dementia. They found that the spinal cords and brains of these three showed the same process as they had already found in the brains of athletes who had been diagnosed post-mortem with Chronic Traumatic Encephalopathy (Punch-Drunk Syndrome or Dementia Pugilistica).

CTE, the BU researchers concluded, was the culprit in causing the three athletes' symptoms, which were consistent with ALS.

If you were to believe widespread media reports last week, this study -- partially funded by the NFL -- had established a link between Lou Gehrig's Disease and concussion.

Regular readers of my weekly column in this newspaper know better. The link was already fairly well established.

In June of 2006, during a multi-part series on the connection between ALS and sports, I reported on an extensive study done by a judge in Italy in 2004. While investigating the use of illegal performance-enhancing drugs among elite soccer players and cyclists, he stumbled on something altogether unexpected.

Yes, the soccer players and cyclists used PEDs. However, among the 24,000 soccer players studied, there were 33 cases of ALS when statistically there should have been one and absolutely no more than two. Furthermore, the age of onset for the affected soccer players was far younger than normal.

Among the 6,000 cyclists? Not a single case.

The soccer players and cyclists were all roughly the same age, engaged in the same high level of activity and used PEDs at comparable rates. The one difference between the two groups? Head trauma. Soccer players experienced it repeatedly from heading the ball, falls and collisions with each other and goal posts. The cyclists suffered it rarely.

Lou Gehrig also experienced an early onset of ALS. He started to show symptoms at age 34 and was diagnosed a year later. The average age for someone to be diagnosed is 64.

Knowing Gehrig's well-documented history of repeated concussion as well as his refusal to miss a game and give himself time to recover, I speculated four years ago that head trauma may have been a contributing factor to his ALS.

The scientists in Boston, when interviewed about the study results they had just released, offered the same speculation -- as if they were to the first to do so.

That is consistent with their conduct over the last two years regarding the link between concussion and dementia. Earlier this summer, they insisted that the two neurosurgeons who are leading the NFL's concussion committee change a statement they had made about the research being done at BU. Initially, Dr. Hunt Batjer (Chairman of Neurosurgery at Northwestern Memorial Hospital in Chicago) and Dr. Richard Ellenbogen had said that the BU research had determined that repeated traumatic brain injury could very well have caused a degenerative process in the brains of some NFL players.

However, the BU researchers insisted the statement be changed to read that the degenerative process had affected all deceased NFL players whose brains had been studied so far. Left unsaid was the fact that all the brains they have examined under a microscope to date belonged to players already diagnosed with dementia.

Unfortunately, theirs is an approach similar to those who would say that since all mackerel are fish then all fish must be mackerel.

Appearing at a concussion conference at Lutheran General Hospital in Park Ridge last month, Mark Lovell, Ph.D., the Pittsburgh neuropsychologist who developed the ImPACT program, summed up what is known and what is not known about concussion. "We know that multiple (brain) injuries can lead to poor outcomes in some athletes," he said. "Kids are at higher risk. Some people develop long-term issues but most don't."

He went on to say that the work being done at Boston University is important but the number of athletes studied so far is too small to make any definitive conclusions. More needs to be done, he concluded, especially in the area of genetics.

That is the most likely lesson to be drawn from all this. There is a small percentage of people, who being genetically predisposed to dementia and ALS, can have one or both triggered by repeated concussions. Determining exactly what that gene is will require much more research.

John Doherty is the sports medicine columnist for The Times. He can be reached at

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