A 36-year-old man received a diagnosis of amyotrophic lateral sclerosis (ALS) 3 months earlier, and he has returned for his first follow-up visit. He hasn’t noticed much change in his physical symptoms, but he is having trouble coping with his diagnosis. He is currently seeing a therapist weekly to help him cope.
He is trying to understand why this has happened to him and asks about the link between sports and ALS. He has read about Orlando Thomas and Kevin Turner, two National Football League players who developed ALS. The patient was a nonprofessional linebacker during high school and college, and he sustained multiple concussions. He asks if that’s what caused his ALS.
How do you answer?
He currently takes riluzole and tolerates it well. Physical and neurological examination findings are unchanged from the previous visit. No early dysphagia is detected. He denies symptoms of nocturnal hypoventilation. Pulmonary function test results are unchanged from the previous visit.
The Patient Health Questionnaire (PHQ-9) reveals that the patient has felt “down” and hopeless more than half of the days in the past 2 weeks. He denies suicidal ideation.
The patient accepts referral to a psychiatrist for further assessment and possible psychotropic medication for his depressive symptoms. He also accepts referral to an ALS support group: http://www.alsa.org/community/support-groups/
1. Roos E, Mariosa D, Ingre C, et al. Depression in amyotrophic lateral sclerosis. Neurology. 2016;86:2271-2277. doi: 10.1212/WNL.0000000000002671.
2. Fang F, Valdimarsdóttir U, Fürst CJ, et al. Suicide among patients with amyotrophic lateral sclerosis. Brain. 2008;131(Pt 10):2729-2733. doi: 10.1093/brain/awn161.
3. Madsen LS, Jeppesen J, Handberg C, et al. “Understanding my ALS”. Experiences and reflections of persons with amyotrophic lateral sclerosis and relatives on participation in peer group rehabilitation. Disabil Rehabil. 2018 Jan 26:1-9. doi: 10.1080/09638288.2018.1429499.
4. Peters OM, Ghasemi M, Brown RH Jr. Emerging mechanisms of molecular pathology in ALS. J Clin Invest. 2015;125:1767-1779.
5. Therrien M, Dion PA, Rouleau GA. ALS: recent developments from genetics studies. Curr Neurol Neurosci Rep. 2016;16:59.
6. Chiò A, Benzi G, Dossena M, et al. Severely increased risk of amyotrophic lateral sclerosis among Italian professional football players. Brain. 2005;128(Pt 3):472-476.
7. Lehman EJ, Hein MJ, Baron SL, Gersic CM. Neurodegenerative causes of death among retired National Football League players. Neurology. 2012;79:1970-1974.
8. Blecher R, Elliott MA, Yilmaz E, et al. Contact sports as a risk factor for amyotrophic lateral sclerosis: a systematic review. Global Spine J. 2019;9:104-118. doi: 10.1177/2192568218813916.