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The Nervous System  
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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.

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Causes  

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

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Risk Factors  

Factors that may increase your risk of getting ALS include:

  • Having a family member with ALS
  • Being in the military or having other occupations with risk of exposure
  • Having certain genetic mutations
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Symptoms  

Symptoms of ALS include:

  • Progressive weakness in arms and legs
  • Wrist or foot drop
  • Difficulty holding things
  • Frequent tripping while walking
  • Muscle twitching
  • Unpredictable and changing emotions
  • Slurred speech
  • Hoarseness and coughing
  • Trouble chewing and swallowing, resulting in frequent choking and gagging
  • Weight loss due to trouble eating
  • Trouble breathing
  • Excess salivation, drooling
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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.

Images may be taken of your bodily structures. This can be done with:

Your bodily fluids and tissues may be tested. This can be done with:

  • Blood tests
  • Lumbar puncture
  • Biopsy

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.

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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:

  • Taking medications
  • Working with therapists and joining a support group
  • Participating in social activities

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.

You may be prescribed these medicines for symptoms:

  • 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 medications
  • 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.
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Prevention  

There are no guidelines for preventing ALS because the cause is unknown.