@article{c97a144e2f9b4133b5ba1aeb8b535458,
title = "Contact Sports as a Risk Factor for Amyotrophic Lateral Sclerosis: A Systematic Review",
abstract = "Study Design: Systematic review. Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease, ultimately resulting in paralysis and death. The condition is considered to be caused by a complex interaction between environmental and genetic factors. Although vast genetic research has deciphered many of the molecular factors in ALS pathogenesis, the environmental factors have remained largely unknown. Recent evidence suggests that participation in certain types of sporting activities are associated with increased risk for ALS. Objective: To test the hypothesis that competitive sports at the highest level that involve repetitive concussive head and cervical spinal trauma result in an increased risk of ALS compared with the general population or nonsport controls. Methods: Electronic databases from inception to November 22, 2017 and reference lists of key articles were searched to identify studies meeting inclusion criteria. Results: Sixteen studies met the inclusion criteria. Sports assessed (professional or nonprofessional) included soccer (n = 5), American football (n = 2), basketball (n = 1), cycling (n = 1), marathon or triathlon (n = 1), skating (n = 1), and general sports not specified (n = 11). Soccer and American football were considered sports involving repetitive concussive head and cervical spinal trauma. Professional sports prone to repetitive concussive head and cervical spinal trauma were associated with substantially greater effects (pooled rate ratio [RR] 8.52, 95% CI 5.18-14.0) compared with (a) nonprofessional sports prone to repetitive concussive head and cervical spinal trauma (pooled RR 0.60, 95% CI 0.12-3.06); (b) professional sports not prone to repetitive head and neck trauma (pooled RR 1.35, 95% CI 0.67-2.71); or (c) nonprofessional sports not prone to repetitive concussive head and cervical spinal trauma (pooled RR 1.17, 95% CI 0.79-1.71). Conclusions: Our review suggests that increased susceptibility to ALS is significantly and independently associated with 2 factors: professional sports and sports prone to repetitive concussive head and cervical spinal trauma. Their combination resulted in an additive effect, further increasing this association to ALS.",
keywords = "amyotrophic lateral sclerosis (ALS), association, athletes, football, meta-analysis, motor neuron disease, risk factor, soccer, sports, systematic review",
author = "Ronen Blecher and Elliott, {Michael A.} and Emre Yilmaz and Dettori, {Joseph R.} and Oskouian, {Rod J.} and Akil Patel and Andrew Clarke and Mike Hutton and Robert McGuire and Robert Dunn and DeVine, {John Glenden} and Bruce Twaddle and Chapman, {Jens R.}",
note = "Funding Information: and the JR van Dijk and the Addessium Foundation. The research leading the studies results has received funding from the European Community{\textquoteright}s Health Seventh Framework Programme COI: van den Berg received travel grants and consultancy fees from Baxter and serves on the advisory board for Biogen and Cytokinetics. Veldink received travel grants from Baxter Rochester Epidemiology Project (Grant number R01-AG034676) COI: Dr Boeve has received personal fees from the Scientific Advisory Board of the Tau Consortium and Isis Pharmaceuticals and grants from GE Healthcare, the National Institutes of Health, the Mangurian Foundation, Cephalon Inc, FORUM Pharmaceuticals, and C2 N Diagnostics, all outside the present work. Dr Mielke serves as a consultant for Lysosomal Therapeutics Inc and holds a grant from the Michael J. Fox Foundation, both outside the present work. Funding Information: Grant from the National Institutes of Health (R01 AG034676), the Rochester Epidemiology Project COI: NR NR COI: NR Funding Information: Grant from the American ALS Association (grant 1542), grant from the European Community{\textquoteright}s Health Seventh Framework Program 2007 to 2013 (grant agreement 259 867), and the Italian Drug Agency COI: E.P.: grants/grants pending, Italian Drug Agency, Italian Ministry of Health, UE. P.M.: grants/grants pending, Italian Drug Agency, Italian Ministry of Health, EISAI, Lombardy Region, Sanofi-Aventis. A.Ch: grants/grants pending: European Union, Italian Ministry of Health; scientific advisory boards, Biogen Idec, Cytokinetics. O.H.: grants/ grants pending, Health Research Board, Merck Serono; consultancy, Biogen Idec, Novartis. E.B.: board membership, Viropharma, EISAI; travel expenses, UCBPharma, GSK; speaking fees, UCB-Pharma, GSK, Viropharma; paid educational presentations, GSK; grants/grants pending, Italian Drug Agency, Italian Ministry of Health, American ALS Association; consulting, GSK. Funding Information: Grant from the National Institute of Neurological Disorders and Stroke (R01 NS27889) COI: NR Funding Information: Grant from ZonMw, The Netherlands Organization for Health Research and Development COI: NR Funding Information: Grants from the Istituto Superiore di Sanita and the American ALS Association. Research was supported in part by the Intramural Research Program of the National Institute of Aging. Publisher Copyright: {\textcopyright} The Author(s) 2019.",
year = "2019",
month = feb,
day = "1",
doi = "10.1177/2192568218813916",
language = "English (US)",
volume = "9",
pages = "104--118",
journal = "Global Spine Journal",
issn = "2192-5682",
publisher = "Thieme Medical Publishers",
number = "1",
}