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.

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Ask a Doctor: Does SI's Big Ben Frontal Lobe Argument Hold Water?

Yesterday Ben posted a story from Sports Illustrated on the blog about how Big Ben's "deviant" behavior may have been caused by frontal lobe injury. I decided to ask our resident blog expert, neurologist Cynthia Brown, MD, who we had consulted previously on Ben Roethlisberger when his concussion issues popped up during the season and the question is whether he should play or not. So we borrowed Cynthia from her DynaMed obligations for a few minutes as she tells us her feelings about whether Roethlisberger's head injuries could have caused his behavioral issues:
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There is not an easy answer to this complex situation. The circumstances of Ben Roethlisberger's 2006 motorcycle accident indicate that he was riding without a helmet and that he suffered enough of an impact to cause multiple facial fractures and loss of teeth (riding without a helmet on that day would indicate bad judgment even before the documented head trauma). There is also documentation of other sports-related concussions.

The article by David Epstein does address the issues well. At first blush, it is difficult to differentiate what may be adolescent-type behavior in a young man with fame and fortune and irresponsible behavior, from that of someone with frontal lobe damage. The acceleration/deceleration head injuries that Ben has experienced can cause brain damage on a cellular level which can result in frontal lobe damage manifested by poor judgment (loss of executive function) and the loss of ability to filter speech and behavior in order to behave in a socially appropriate fashion (disinhibition). Damage to the temporal lobes (which can also occur from acceleration/deceleration head trauma) can also result in certain deviant sexual behaviors, but this would be highly unusual. I agree with the comments of the neurologists and neuropsychologists that determination of his behavior patterns earlier in life as well as extensive neuropsychological testing will be able to determine whether this is the behavior of an egotistical man or inappropriate behavior of a brain-damaged individual.

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Thank you to Cynthia for once again providing us with some expert opinion here at NYaT!