How is amyotrophic lateral sclerosis ALS treated

Treatment of symptoms of ALS (amyotrophic lateral sclerosis)

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The symptomatic therapy of amyotrophic lateral sclerosis (ALS) aims to alleviate the side effects of the disease as much as possible. Different methods and drugs are available for this.

Treatment of cramps in ALS

There are some proven drugs for treating cramps. Magnesium can be given in addition to these. Regular physiotherapy is important, if necessary in conjunction with hydrotherapy (water therapy).

Therapy of muscle twitching (fasciculations)

These small, externally visible muscle twitches also occur in healthy people and are often completely harmless. But they are also a typical symptom of ALS and are perceived by the sick as very unpleasant. Therapeutically, there is the possibility of relieving muscle twitching, for example by means of detonating measures (reduction of muscle tension) as part of physiotherapy.

Treatments for paralysis in ALS

Functional disorders such as paralysis cannot be treated in ALS. Instead, the aim of therapy is to maintain residual function and avoid painful misalignments.

Therapy of spasticity

Regular physiotherapy is recommended for severe spasticity. Hydrotherapy (water therapy) with exercises in warm pools (32 - 34 °) and cryotherapy (targeted use of cold) can be helpful. Antispastics (antispasmodics) such as baclofen and tizanidine can also help. However, these drugs should be used in as low a dose as possible, as muscle relaxation can increase the symptoms of paralysis.

Therapy for speech disorders (dysarthria)

At an advanced stage, ALS patients often experience speech disorders, so-called dysarthrias. Treatment by speech therapists (speech therapists) can help to maintain speech intelligibility for as long as possible. In the case of advanced speech disorders, it makes sense to use aids such as computers with speech output.

Swallowing disorders (dysphagia) in ALS

In the course of the ALS disease, patients often develop swallowing disorders, so that the food must have a certain consistency. Food that is too liquid or too solid is very difficult for those affected to consume. If necessary, high-calorie food supplements (astronaut food) can be prescribed. With the help of a speech therapist, the person affected can also learn certain swallowing techniques that make eating easier. However, as the disease progresses, swallowing can become increasingly impaired or impossible.

Apart from the complications that this causes, malnutrition and the resulting weakness must be counteracted. Percutaneous endoscopic gastrostomy (PEG) tube feeding is required. This is placed from the outside through the skin with access to the stomach. The patient can be supplied with such a feeding tube if he can no longer eat enough. In any case, it is important to adapt the way of eating to the respective stage of the disease and to maintain normal eating for as long as possible, as this is largely associated with well-being, sociability and a pleasant atmosphere.

Treating excessive salivation (sialorrhea)

The paralysis of the muscles in the mouth area and the disturbed act of swallowing often lead to ALS patients suffering from so-called sialorrhea - the saliva flows out of the mouth unhindered. Those affected usually find this very stressful. There is also a risk of saliva getting into the windpipe and lungs and causing breathing problems.

Therefore, therapeutic efforts are being made to reduce saliva production. So-called anticholinergics are used here. Injecting botulinum toxin type A (Botox) into the salivary glands or irradiating the salivary glands can also reduce the flow of saliva.

Compulsive laughing and crying in ALS

About half of all ALS patients suffer from compulsive laughing or crying, sometimes or from compulsive yawning. This so-called affect lability can become a burden for both the patient and the social environment, but it can be treated with medication. Various active ingredients that are also used to treat depression, such as lithium or citalopram, can be used for this. Dopamine is also used. Treatment may be dispensed with if the seizures do not occur frequently or are not felt to be very distressing.

Breathing problems (respiratory failure)

At the end of the typical course of ALS disease, progressive paralysis of the respiratory muscles and the associated breathing problems occur. At the beginning of this last phase of the disease, patients often complain of sleep disorders, daytime sleepiness or shortness of breath when speaking. Initially, the symptoms can be positively influenced with accompanying respiratory therapy through physiotherapy.

However, patients must now decide whether they want artificial ventilation in the case of complete respiratory insufficiency or whether they want to forego this measure. Medication can help people who decide not to use artificial respiration. Patients should definitely write an advance directive so that they can be sure that their wishes will be met by relatives and doctors.

Ventilation is provided - as far as possible - in the form of non-invasive ventilation through a mask, sometimes initially only at night. The atman network for respiratory care reports on patients in the USA who have been artificially ventilated for more than ten years with a good quality of life.

The subject of ventilation is an area that requires extensive preparation and a great deal of knowledge. Timely education and planning are very important for the individual patient.
  • Author: Dr. Susanne Segebrecht, Charité - University Medicine Berlin; Markus Zens, science journalist, research associate Charité - Universitätsmedizin Berlin; medical quality assurance: Cornelia Sauter, doctor;
  • Swell: Amyotrophic lateral sclerosis, guidelines for diagnosis and therapy in neurology; 4th revised edition, ISBN 978-3-13-132414-6; Georg Thieme Verlag KG, Stuttgart
  • Amyotrophic lateral sclerosis (ALS): A guide for those affected and caregivers atman - Netzwerk für Ventilationspflege e. V., March 2011
  • Kollewe, K, Andersen PM, Borasio GD et al .: Clinical guidelines for the treatment of amyotrophic lateral sclerosis. Neurology 4/2008
  • Rosseau, Simone, Charité Center for Out-of-Hospital Ventilation and Oxygen Therapy (CABS): ventilation therapy. Lecture on ALS day in the Charité - Universitätsmedizin Berlin, March 19, 2011
  • Amyotrophic lateral sclerosis (motor neuron diseases), guidelines for diagnostics and therapy in neurology. German Society for Neurology. http://www.awmf.org/uploads/tx_szleitlinien/030-001l_Amyotrophe_Lateralsklerose_ALS_2015-06.pdf

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