Ask a Doctor: Could Lou Gehrig Have Not Had His Own Disease?

Yesterday the New York Times' Alan Schwarz (who has seemed to champion the brain damage and sports cause for the Times) wrote an article with the title that basically read "Did Lou Gehrig Have Lou Gehrig's Disease" (I'm paraphrasing the title since it has since been changed to "Study Says Brain Trauma Can Mimic A.L.S." after some initial controversy). Some followed up on the research and some blasted the way it was presented.

The man who bears the name of ALS (NPR)

I felt it was best to go to our resident blog expert and neurologist, Cynthia Brown, MD. Cynthia was formerly a practicing Neurologist for over 20 years at Fallon Clinic as well as President of the Medical Staff at St. Vincent Hospital at Worcester Medical Center. She now works for an EBSCO subsidiary, DynaMed. Here's what she had to say on the very interesting and controversial topic:
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Today's article in the Journal of Neuropathology and Experimental Neurology summarizes previously published literature linking amytrophic lateral sclerosis to traumatic brain injury and discusses the autopsy findings of 3 athletes who appear to have had a history of repeated head trauma and developed findings similar to amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease, motor neuron disease). The news story that Lou Gehrig may not have had Lou Gehrig's disease has sparked much interest.

Motor neuron disease most probably will eventually turn out to be several different diseases. There are circumstances where ALS has a genetic basis, and there are other cases, such as that of Stephen Hawking, that have a very slow progression which is different from the more rapid typical course.

The new article refers to the previously reported unusually high rate of ALS among Italian professional soccer players, and the association of increased incidence of ALS in Canadian and National Football league players. Other reported associations with ALS are mentioned and include pesticides, cigarette smoking, and other toxic exposures.

The paper highlights the findings of both conditions of chronic traumatic encephalopathy (CTE) due to repeated head injury and ALS (motor weakness,shrinking and twitching of muscles) among athletes who had experienced repetitive head injury and concussions. The pathology (autopsy findings) of only 3 athletes who had evidence of both CTE and typical motor findings of ALS are the basis of the theory presented in the paper of the trauma being the trigger for an ALS-like illness. All 3 of these athletes also had dementia and/or behavioral changes that had preceded the onset of their weakness.

The paper does present an interesting theory and may help give further insight the causes of a neurodegenative disease that is not well understood. However, this paper will not resolve whether Lou Gehrig had the disease that bears his name, but does once again highlight the dangers associated with repeated head trauma in collision sports.

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Thanks again to Cynthia for that great work. The end of Cynthia's conclusion about the dangers of head trauma in sports is certainly a hot topic of debate. We talked about it with Ben Roethlisberger but I think that players, teams and the media are only recently starting to take notice.

Regardless if Gehrig had ALS or not, the fact that anyone could confuse ALS with multiple, mistreated concussions should be a serious wake-up call to anyone in sports who sustains a head injury. Baseball has been rolling out new, concussion-proof helmets (the larger ones worn by Francisco Cervelli and David Wright the past two years, but new, svelter ones were worn by certain players during the All-Star Game as well) and football is just now studying the effects of concussions on its players (and I certainly though about this when I saw Eli Manning get obliterated this past Monday night and left the game with a bloody head).

Sometimes it takes a reporter like Schwarz who has repeatedly put head trauma in sports in a new light or for serious injuries to be caused to players for anyone to take notice. Hopefully this is just the type of wake-up call that professional sports needs to treat concussions more seriously.