What is the treatment for ALS?

Currently available ALS treatments cannot reverse any of the damage done by the condition, however, they are able to slow down the rate at which the symptoms progress, prevent some of the complications and allow for the patient to be more independent and comfortable.

Effective treatment may require a cooperative team consisting of various doctors and specialists that are trained in a number of different areas as the treatment is often complex, it does, however, prolong the patient’s life and the quality thereof.

The following is a list of treatment options. The team of specialists involved will work towards finding the most effective means and a combination of treatment for the individual.

Medications used in managing ALS

There are two medications that have been FDA approved for the treatment of amyotrophic lateral sclerosis or motor neuron disease:

• Riluzole (Rilutek) – This is a drug that has shown to slow down the progression of ALS in some patients. This can be due to the levels of glutamate (chemical messenger found within the brain) being reduced by this drug. This chemical, as previously mentioned, often exists in higher quantities in those with ALS which leads to nerve cell damage. Rilutek is taken in the form of a pill and can lead to changes in liver function, dizziness and gastrointestinal conditions.
• Edaravone (Radicava) –  This is an FDA approved drug that is administered intravenously over a period of 10 to 14 consecutive days or once a month. Gait disturbances (this is a deviation from walking normally), swelling, hives and a shortness of breath are some of the side effects. Patients with a sulfite sensitivity may also have an allergic reaction to this drug as it contains sodium bisulfite.

The doctor is likely to also prescribe some of the below medications in order for some relief to be provided from the symptoms. These include medications for:

• Muscle spasms and cramps
• Spasticity
• Excessive salivation
• Uncontrollable outbursts of crying or in some rare cases, crying
• Fatigue
• Pain
• Sleep problems
• Constipation
• Depression
• Excessive phlegm

ALS therapies

• Physical therapy – This kind of treatment involves a physical therapist who is able to address and assist with the pain associated with mobility and walking and provide the individual with equipment to aid them in staying somewhat independent. Walkers, wheelchairs and braces can be adjusted for the patient. As well as this, ramps may also be suggested for the individual’s home to make moving around more accessible. A PT (physical therapist) is able to assist the patient in practising some low-impact stretches and exercises in order for them to maintain their cardiovascular fitness, motion range and muscle strength until the condition progresses into complete paralysis.  
• Breathing care – Breathing will become increasingly difficult as the disease progresses and the muscles needed for breathing weaken. Because of this, the patient’s breathing may be regularly tested and he or she may be given non-invasive devices to help them to breathe at night. As previously mentioned, mechanical ventilation may be needed. This requires a tube to be inserted through a hole in the patient’s neck that leads to their windpipe. This tube will be connected to the respirator. A respirator is a machine that induces artificial respiration (breathing).
• Occupational therapy (OT) – This form of treatment is done through an OT (occupational therapist) who can help the patient to find ways that they can remain as independent as possible, regardless of their arm and hand weakness. An OT can also aid in adapting the patient’s home to modify it to suit their needs of mobility. They can also implement adaptive equipment to perform their daily activities which include grooming, dressing, bathing and eating. Adaptive equipment or technologies are devices that can be adapted to suit the needs of the individual in order to enhance their mobility such as adjustable beds that help the patient to sit up. In addition, OTs possess a thorough understanding of assistive computers to help with speech issues.
• Nutritional support – The medical team will work with the patient and their family to ensure that the individual is meeting their nutritional needs. Eventually, a tube for food to enter the body (feeding tube insertion) will be introduced as swallowing becomes an issue.  
• Speech therapy – Due to ALS affecting the muscles needed to speak, the communication for a patient with advanced ALS can become an issue. Through seeing a specialist in speech therapy (speech therapist), the patient will be able to learn adaptive techniques and technologies to help them communicate more clearly. A patient can also speak to their therapist about renting or borrowing assistive devices including computers or tablets that have text-to-speech programs as this can be a less expensive option than some of the more advanced Brain Computer Interface devices.
• Social and psychological support – Someone to help with the overall wellbeing of the patient and their loved ones is known as a clinical social worker. This person may also be needed to aid with any financial issues, sourcing and purchasing equipment and insuring it. Psychologists can also help in providing counselling and emotional care and support for the patient and their family. 

Clinical studies on ALS

There have been a number of clinical studies that have promising results regarding future treatment and medication options for ALS. A patient’s eligibility for joining one of these studies will depend on a number of aspects related to their condition. Bear in mind that although some studies have positive results, their outcomes are not guaranteed. It is best that a patient speaks to their doctor regarding any clinical studies they may have heard about or want to partake in.