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Amyotrophic Lateral Sclerosis

(ALS; Lou Gehrig's Disease; Motor Neuron Disease)

Definition

Amyotrophic lateral sclerosis (ALS) is a progressive nervous system disorder. It gradually destroys the nerves responsible for muscle movement. Over time, ALS leads to almost total paralysis of muscle movement, including breathing. Eventually, the disorder leads to respiratory failure.
The Nervous System
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Causes

The cause of ALS is unknown. Genes may play a role.

Risk Factors

Factors that may increase your chance of ALS include:

Symptoms

Symptoms of ALS include:

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. There are no tests that can diagnose ALS. Tests may be used to rule out other medical conditions.
Imaging tests may include:
Other tests may include:
Your muscles and nerves may be evaluated. This can be done with electromyogram (EMG)/nerve conduction velocities (NCV).
Your cognitive skills may be assessed. This can be done with neuropsychological testing.

Treatment

There is currently no cure for ALS.
Treatment may help to reduce or manage symptoms. A combination of treatments may work best. This may include:
Treatment options include:

Medications

The drug riluzole has been approved for ALS. The drug may slightly improve functioning, but it does not stop the disease from progressing.
Medications may include:
  • Muscle relaxants reduce spasticity
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) and other pain medications
  • Atropine, scopolamine, botulinum toxin, antihistamine—To reduce heavy drooling
  • Antidepressants and anti-anxiety drugs
  • A combination of dextromethorphan and quinidine—to treat inappropriate laughter or crying

Other Types of Treatments

Supportive care may be needed as ALS progresses, including:
  • Physical therapy—To reduce pain associated with muscle cramping and spasticity.
  • Respiratory care—In some cases, you may need to receive a mixture of air and oxygen from a machine. A device may also be used that helps your breathing muscles contract. If you cannot move enough air in and out of your lungs, you may need surgery to have a tube inserted into your airway.
  • Nutritional care—Your doctor may make changes to your diet. In some cases, getting nutrition through tube feeding is needed.
  • Speech therapy—Speech therapy may be used to optimize communication. Therapy may include exploring alternate methods of communication.

Prevention

There are no current guidelines to prevent ALS because the cause is unknown.

RESOURCES

ALS Association http://www.alsa.org

National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

CANADIAN RESOURCES

ALS Society of British Columbia http://www.alsbc.ca

ALS Society of Canada http://www.als.ca

References

Aggarwal, SP, Zinman L, et al. Clinical trial testing lithium in ALS terminates early for futility. Lancet Neurol. 2010;9(5): 481-488.

Amyotrophic lateral sclerosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 4, 2014. Accessed February 12, 2014.

Amyotrophic lateral sclerosis fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/amyotrophiclateralsclerosis/detail%5Famyotrophiclateralsclerosis.htm. Updated February 5, 2014. Accessed February 12, 2014.

FDA approves NeuRx Diaphragm Pacing System. ALS Association website. Available at: http://www.alsa.org/news/archive/fda-approves-neurx-diaphragm.html. Updated September 29, 2011. Accessed February 12, 2014.

NeuRx Diaphragm Pacing System. US Food & Drug Administration website. Available at: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm278684.htm. Updated September 6, 2013. Accessed February 12, 2014.

Sathasivam S. Managing patients with amyotrophic lateral sclerosis. Eur J Intern Med. 2009;24:355-358.

Walling AD. Amyotrophic lateral sclerosis: Lou Gehrig's disease. Am Fam Physician. 1999;59:1489-1496.

4/17/2008 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Fornai F, Longone P, et al. Lithium delays progression of amyotrophic lateral sclerosis. Proc Natl Acad Sci USA. 2008;105:2052-2057.

1/14/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mateen FJ, Carone M, et al. Patients who survive 5 years or more with ALS in Olmsted County, 1925-2004. J Neurol Neurosurg Psychiatry. 2010;81(10):1144-1146.

9/3/2014 DynaMed's Systematic Literature Surveillance. Available at: http://www.ebscohost.com/dynamed: Wippold FJ, Cornelius RS, et al. American College of Radiology (ACR) Appropriateness Criteria for dementia and movement disorders. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/DementiaAndMovementDisorders.pdf. Updated 2014. Accessed September 3, 2014.

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