Gehrig's etiology

A paper being published in the Journal of Neuropathology and Experimental Neurology is reporting that in three autopsies of athletes with motor neuron disease, TDP-43 and tau deposits were found extending to the spinal cord. The athletes' motor neuron disease mimicked ALS but was distinct pathologically. The New York Times explored how this finding may alter our understanding of Lou Gehrig's disease, the disease whose name has become inseparable from its famous sufferer. Gehrig's sports career was accompanied by a number of head traumas and concussions, so his disease may not have been the same as the majority of other ALS patients. The situation is analogous to Muhammed Ali's relationship to Parkinson's disease. Ali suffers from dementia pugilistica, parkinsonism its most visible manifestation, secondary to his history of occupational head trauma. Even Michael J. Fox, whose Parkinson's disease began when he was young, doesn't represent the median PD patient. Nevertheless, any celebrity attracts attention and eventually money to a disease.

The recent finding underscores what has become increasingly clear about neurodegenerative diseases, specifically Alzheimer's, Parkinson's, and ALS: they are all complex diseases with complex etiologies. In some patients, e.g. athletes, head trauma may play a major role in their development, but not all athletes develop disease. In non-athletes, even minor head trauma may contribute to a lifetime of accumulating neuronal damage and loss. Regardless of its relative contribution to an individual's disease, the neurodegenerative consequences of head trauma, via inflammation or structural damage, deserve further study.