Amyotrophic lateral sclerosis in an Italian professional soccer player

Amyotrophic lateral sclerosis (ALS) is a rare devastating neurodegenerative disease of unknown etiology. Two recent epidemiological studies showed a high risk for ALS among Italian male soccer players. We present the clinical and occupational history of an Italian professional soccer player affected by sporadic ALS. The early onset of ALS (45 years), the bulbar form, the playing position (midfielder) and the duration of the job as professional soccer (17 years) are four characteristics of this patient that are in good agreement with the findings in the previous epidemiological studies. This patient reports the frequent consumption of fructose 1,6 biphosphate, extracts of suprarenal cortex, crotetamide and cropropamide, and dietary supplements (branched chain amino acids and creatine) during his playing career. Some hypotheses have been proposed to explain this high excess of deaths for ALS among soccer players: (a) vigorous physical activity; (b) soccer specific trauma or microtrauma; (c) use of illegal toxic substances or chronic misuse of drugs (most often anti-inflammatory) and dietary supplements; and (d) exposure to pesticides used on playing fields. The overall available clinical and epidemiological evidence supports the possible relation between the specific occupational environment (soccer) and the occurrence of ALS in this patient.