Amyotrophic Lateral Sclerosis (ALS / Lou Gehrig's Disease)
Definition
Amyotrophic lateral sclerosis (ALS) is a disease of the nervous system. It leads to the damage of nerve cells in the brain and spine. These nerves control muscle movement. People with ALS have muscles that weaken and shrink as the disease gets worse.
| The Nervous System |
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Causes
The exact cause is not known. Genes and the environment may play a role.
Risk Factors
ALS is more common in men and in people who are 50 to 75 years of age. Other things that may raise the risk are:
- Having a family member with ALS
- Having certain genetic changes
Symptoms
The first symptoms of ALS may be:
- Changes in speech
- Tripping while walking
- Problems with fine motions like grasping a pen
Problems get worse over time and result in:
- Hoarseness and coughing
- Slurred speech
- Muscle twitching
- Weakness in the arms and legs
- Problems raising the hand or foot or holding things
- Problems chewing, swallowing, and weight loss due to trouble eating
- Drooling
- Problems breathing
- Mood swings
Diagnosis
The doctor will ask about symptoms and health history. A physical exam will be done. There are no tests to diagnose ALS.
Tests will be done to rule out other health issues that cause similar problems. These may be:
- Blood and urine tests
- Images of the brain and spine using:
- Lumbar puncture—to look for changes in the fluid that surrounds the brain and spinal cord
- Biopsy to closely examine muscle and nerve tissue in a lab
- Electromyogram—to look at problems with the connection between the nerves and muscles
The care team will look at a person's symptoms and test results before making a diagnosis. A second opinion with a doctor who focuses on nerves may help confirm the diagnosis.
Treatment
The goal of treatment is to manage symptoms. There is no cure. Ways to do this are:
Medications
Some medicines may help slow the disease. Others may be used to:
- Ease pain
- Relax muscles that are in spasm
- Reduce heavy drooling
- Manage depression and anxiety
- Treat inappropriate laughter or crying
Supportive Care
A team of specialists will work with a person to create a care plan. The plan will focus on quality of life for the person and their family.
ALS will affect muscles throughout the body. Chewing, swallowing, speech, and breathing can all be affected. Care will help support the body when these changes occur. Ways to do this are:
- Physical therapy to ease muscle cramping and spasms
- Help with breathing, such as oxygen, breathing machines, or making an airway in the base of the neck
- Improving nutrition through supplements or a feeding tube
- Speech therapy to improve communication
- Mental health counseling and support groups to help people with ALS and their family members cope with the stress of this health problem
Prevention
ALS cannot be prevented.
References
- Amyotrophic lateral sclerosis. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/amyotrophic-lateral-sclerosis-als.
- Amyotrophic lateral sclerosis (ALS) fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/amyotrophic-lateral-sclerosis-als-fact-sheet.
- Brent, J.R. and Ajroud-Driss, S. Amyotrophic lateral sclerosis: Integrated care provides the best quality of life. Pract Neurol (Fort Wash Pa), 2019; 18: 46-49.
- Brent, J.R., Franz, C.K., et al. ALS: management problems. Neurol Clin, 2020; 38 (3): 565-575.
- What is ALS? ALS Association website. Available at: https://www.als.org/aunderstanding-als/what-is-als.html.