How is ALS treated?
Patient history and exam
Your health care provider will take a medical history and physical exam. The physical exam usually includes an extensive strength and endurance exam. This will assess the patient’s degree of muscle weakness throughout the body. This may show weakness beginning in a particular area, muscle tremors, spasms, twitching or atrophy. A patient with ALS may even present with an abnormal gait (they may have a stiff or clumsy walk).
Reflexes are often abnormal in that they will be increased at the joint and reduced in the gag reflex. Some patients may have trouble controlling episodes of crying or laughing, often called “emotional incontinence.”
Blood tests may be used to rule out other conditions that lead to muscle weakness. MRI or CT scans may be required to rule out other diseases or injury to the neck which can often mimic ALS symptoms. Electromyography (EMG) will help to determine which nerves are being affected by the disease. Additional swallowing studies and pulmonary function tests may assist in diagnosis and treatment protocols. Genetic testing is commonly suggested by the physician if there is a family history of ALS or to obtain information for current nerve studies.
Unfortunately, scientists are unaware of what causes ALS, and the disease currently cannot be cured. Even though physicians cannot reverse the progression and symptoms of ALS, there have been considerable medical advances which extend and improve the life of patients with this disease. Neurologists trained in neuromuscular conditions and other health care specialists work as a team to care for patients with this complex condition. Often this treatment is focused on relieving symptoms and maintaining good quality of life. Therapy may differ from person to person, and the treatment plan may be changed often as the disease progresses.
Physical therapy is very important to help patients relieve cramping and muscular pain. Passive stretches and daily movement help prevent permanent contraction of muscles. If muscles become contracted, they may cause joint problems and develop permanent stiffness. Other therapies, such as speech therapy, may help the patient work mouth and swallowing muscles to extend their function.
Some drugs, such as riluzole, may be prescribed to extend life expectancy by reducing damage to motor neurons. This treatment may not be for every patient, but it has been approved by the U.S. Food and Drug Administration for the treatment of ALS.
Other drugs, such as baclofen (Lioresol®) or tizanidine (Zanaflex®), are used to relieve spasticity. The health care team may try several drug combinations, and changes may be made as the disease progresses. However, none of these treatment options is a cure for ALS, and they are only effective at slowing disease progression and prolonging life.