Amyotrophic Lateral Sclerosis Treatment
There is no cure for ALS. Treatment focuses on relieving symptoms and maintaining an optimal quality of life. Treatment is based on individual therapy and the continual adaptation of medications. Riluzole (Rilutek®) is one of the few drugs so far proven to be effective against ALS and may prevent progression and prolong life for a few months or so. Riluzole decreases the release of glutamate.
Side effects include the following:
- Elevated liver enzymes
- Reduced leukocytes in the blood (granulocytopenia)
- Weakness (asthenia)
Baclofen (Lioresol®) or tizanadine (Zanaflex®) may relieve spasticity. Side effects include increased weakness, sedation, and dizziness. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may relieve general discomfort. Due to potentially severe gastrointestinal and cardiovascular side effects, NSAIDs should only be used as instructed. Tramadol (Ultram®) is often prescribed for pain relief.
Physical therapy is an important part of treatment and helps to relieve cramping and muscular pain. Passive stretching helps to avoid permanent contraction of muscles (contractures) that may cause joint problems.
Other therapies, such as occupational therapy and speech therapy, are also used in treatment. ALS patients require a diet of high-energy foods that are easy to swallow. Patients may benefit from a nutritionist. If the patient is not able to maintain adequate nutrition, a percutaneous endoscopic gastrostomy (PEG), or feeding tube, is usually inserted. This has been shown to prolong life in ALS patients who are losing weight.
Some ALS patients may also need pulmonary consultants and respiratory therapists to assist breathing. Fewer than 5% of patients use long-term ventilation support. Noninvasive forms of breathing assistance (e.g., continuous positive airway pressure [CPAP], bilevel positive airway pressure [BiPAP]) may be used to improve the patient's quality of life.
Depression is very common among ALS patients. Antidepressant medication and counseling can help patients and their families cope.
Amyotrophic lateral sclerosis is a terminal illness. Fifty percent of patients die within 3 years of diagnosis; 20% live 5 years; and 10% live 10 years. Hospice care can provide comfort and dignity to patients and their loved ones.
Resources for patients and caregivers are available from the ALS Association and the ALS Division of the Muscular Dystrophy Association.