Sports and trauma as risk factors for Motor Neurone Disease: New Zealand case–control study

Abstract

Objectives To assess whether sports, physical trauma and emotional trauma are associated with motor neurone disease (MND) in a New Zealand case–control study (2013–2016). Methods In total, 321 MND cases and 605 population controls were interviewed collecting information on lifetime histories of playing sports, physical trauma (head injury with concussion, spine injury) and emotional trauma (14 categories). ORs were estimated using logistic regression adjusting for age, sex, ethnicity, socioeconomic status, education, smoking status, alcohol consumption and mutually adjusting for all other exposures. Results Head injury with concussion ≥3 years before diagnosis was associated with MND (OR 1.51, 95% CI: 1.09–2.09), with strongest associations for two (OR 4.01, 95% CI: 1.82–8.86), and three or more (OR 2.34, 95% CI: 1.00–5.45) head injuries. Spine injury was not associated with MND (OR 0.81, 95% CI: 0.48–1.36). Compared to never playing sports, engaging in sports throughout childhood and adulthood increased MND risk (OR 1.81, 95% CI: 1.01–3.25), as was more than 12 years playing football/soccer (OR 2.35, 95% CI: 1.19–4.65). Reporting emotionally traumatic events in more than three categories was associated with MND (OR 1.88, 95% CI: 1.17–3.03), with physical childhood abuse the only specific emotional trauma associated with MND (OR 1.82, 95% CI: 1.14–2.90), particularly for those reporting longer abuse duration (OR(5–8 years) 2.26, 95% CI: 1.14–4.49; OR(>8 years) 3.01, 95% CI: 1.18–7.70). For females, having witnessed another person being killed, seriously injured or assaulted also increased MND risk (OR 2.68, 95% CI: 1.06–6.76). Conclusions This study adds to the evidence that repeated head injury with concussion, playing sports in general, and playing football (soccer) in particular, are associated with an increased risk of MND. Emotional trauma, that is physical abuse in childhood, may also play a role.

Neurodegenerative disease risk among former international rugby union players

“…Limited data suggest exposure to TBI, including sports concussion, might serve as a risk factor for MND 33–36. However, the risk observed in this study and similar athlete studies appears several-fold higher than that reported from research looking at non-sport associated TBI 36. As such, the possibility that head impacts and/or TBI in sport lead to greater risk of MND than non-sports TBI, or that an additional, unknown risk factor contributes to the remarkably high risk observed among these populations, might be considered.…”

“…Furthermore, as we had to allocate an MND event to the comparison group, to obviate the problem of a zero count, the reported effect size is likely to be an underestimate of the true strength of association. Limited data suggest exposure to TBI, including sports concussion, might serve as a risk factor for MND 33–36. However, the risk observed in this study and similar athlete studies appears several-fold higher than that reported from research looking at non-sport associated TBI 36.…”

“… 33–36 However, the risk observed in this study and similar athlete studies appears several-fold higher than that reported from research looking at non-sport associated TBI. 36 As such, the possibility that head impacts and/or TBI in sport lead to greater risk of MND than non-sports TBI, or that an additional, unknown risk factor contributes to the remarkably high risk observed among these populations, might be considered. Certainly, there is an immediate need for further, robust studies considering the specific association between sport, traumatic brain injury and risk of this rare, but uniformly fatal, outcome.…”

Chronic Traumatic Encephalopathy in Soccer Players: Review of 14 Cases

“…Repetitive head injuries with concussion over a period of 15 years, playing sports in general, and playing soccer in particular are a risk factor for ALS. [114][115][116] A meta-analysis of more than 37 000 male professional soccer players showed a significantly higher mortality risk from motor neuron disease. 117 In a cluster of professional soccer players, a 6,5-fold risk of developing ALS was found, compared with the general population.…”

The Role of Stress in the Progression of Motor Neuron Disease: Mechanisms and Implications for Treatment

“…Adverse events, such as prior exposure to heavy metals (including lead), pesticides, physical trauma/injury, electric shock history, and prior exposure to organic solvents, are significantly associated with the progression of MND and serve as risk factors for MND [3]. A study of the New Zealand population revealed that cranial trauma, prolonged strenuous exercise, and emotional trauma (particularly in patients 162 with chronic mental stimulation) can cause MND to progress faster compared with the general population, which experienced none of the above [41]. Interestingly, certain psychological interventions can significantly improve the quality of life for MND patients [42,43].…”