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To the Editor:
I read with interest the case-control study by Scarmeas et al. reporting a significant association between amyotrophic lateral sclerosis (ALS) and a history of participating in varsity athletics (OR = 1.70, 95% CI 1.04 to 2.76).1
In an epidemiologic study performed on 24,000 professional Italian soccer players, the distribution of the causes of death of 350 Italian soccer players has been analyzed in terms of standardized proportional mortality ratio (SPMR).2 Mortality for motor neuron disease (International Classification of Diseases–10 revision 335.2) between 1960 and 1996 was very high (SPMR = 11.6; …
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