Treatment with Rasagiline in Patients with Amyotrophic Lateral Sclerosis

OBJECTIVE: Review the literature from 2003 to 2006 to determine if new data change the conclusions of a previous review (Neuroepidemiology 2003; 22:217-228) that sports and trauma are probably (“more likely than not”) not risk factors for developing ALS. BACKGROUND: Reported apparent excess occurrence of ALS in professional Italian soccer players has rekindled the discussion, whether sports or trauma are risk factors for ALS. METHODS: A Medline search was conducted for the years 2002 – 2006. Original articles were classified using evidencebased methods. The expected number of cases of ALS in the Italian soccer player cohorts was re-calculated independently, assuming complete case finding in the reference cohort. Previous evidence was considered in updating conclusions. RESULTS: Two reports showed that physical activities and sports were associated with reduced risk of, or not associated with, ALS (Class III). A third concluded that varsity athletics and low BMI were risk factors for ALS (Class IV). There was no excess of ALS in Italian soccer players (two articles, Class III). CONCLUSIONS: 1. Trauma and physical activity are probably not risk factors for ALS (Level B, unchanged). 2.There is possibly no excess of ALS in professional Italian soccer players (Level C). Dr. Armon has provided expert opinion in cases in which trauma was alleged to have caused ALS.