From ALS Association
August 5, 2003

In May of this year, there was a media report of a suspected cluster of
ALS among Italian soccer players. This is an important observation and
warrants scientific study, although at this time it is not clear exactly
what the possible association between ALS and soccer playing may be. Since
the initial report, the Miami Herald and the National Italian American
Foundation have announced and published story updates. In its July 30th
2003 story, ?ALS Prober Looking at Soccer Move,? the Miami Herald reports
that a 10-year British study is underway to track the health of soccer
players following the deaths of some British soccer players.

Reports of seemingly increased numbers of cases of ALS among athletics and
people with athletic body types are not new. Such observations have been
reported over the past few decades. Several studies have been conducted
based on many of these reports. Some of them are suggestive and
interesting, and others have been negative. No conclusive evidence of any
specific associations between athletic activities or body type and ALS has
been demonstrated, but there are suggestions that need to be clarified
with more research.

At this time, many scientists are interested in how the environment -
including life style, activities, occupational exposures, diet and
environmental toxicants may play a role in ALS - especially in someone who
may be genetically susceptible for developing ALS. All of this is still
speculation, but a number of scientists believe there is rationale for
this theory to contribute, at least in some part, to the pathogenesis of
ALS.

Epidemiological review and possible study of this report of increased
cases of ALS among the Italian soccer players is important. A
well-controlled study could answer the question of whether there is or is
not a true increase in the incidence of ALS among these athletes, or if
the number of cases can be explained by chance alone. If there is a true
cluster here, looking for risk factors and associations could provide a
better understanding of ALS and even possible targets for treatment.

The ALS Association has taken a number of steps to support and encourage
scientific investigation into the possible role of environmental and life
style exposures in development of ALS. ALSA sponsored a scientific
workshop on this topic in May 2003. Five studies funded last year by the
Agency for Toxic Substances and Disease Registries (associated with the
CDC) include ALS. The ALS Association has been involved in the Gulf War
ALS studies and the new Veterans Affairs Registry. The investigation of a
suspected increase in ALS incidence related to Kelly Air Force Base
included ALSA advisors and a prominent role in case ascertainment by The
ALS Association?s South Texas Chapter.

The suspected cluster of ALS reported among Italian soccer players
deserves further exploration to determine if there are risk factors or
other information that can lead to a better understanding of the disease.