Lou Gehrig's Disease (ALS)

Treatment

Medication

The physician bases medication decisions on on the patient's symptoms and the stage of the disease. Some medications used for ALS patients include:

• Riluzole — This is the only medication approved by the U.S. Food and Drug Administration (FDA) to slow the progress of ALS. Though it does not reverse ALS, riluzole has been shown to reduce nerve damage. Riluzole may extend the time before a patient needs a ventilator (a machine to help breathe) and may prolong the patient's life by several months.
• Baclofen or diazepam — These medications may be used to control muscle spasms, stiffness or tightening (spasticity) that interfere with daily activities.
• Trihexyphenidyl or amitriptyline — These medications may help patients who have excess saliva or secretions, and emotional changes.

Other medications may be prescribed to help reduce such symptoms as fatigue, pain, sleep disturbances, constipation, and excess saliva and phlegm.

Rehabilitation

As ALS progresses and muscles weaken, the patient may benefit from rehabilitation services to enhance independence and maintain safety. The physician may recommend several types of therapy.

Physical and Occupational Therapy

Physical therapy may involve low-impact exercises such as walking, swimming and stationary-bicycle riding to strengthen muscles, improve cardiovascular health and help the patient fight fatigue and depression. In addition, range of motion and stretching exercises can help prevent muscle spasms and cramping, and maintain range of motion. Occupational therapy involves learning to use assistive devices, such as a wheelchair, and how to do daily tasks.

Speech Therapy

Because ALS affects the muscles used to speak, a speech therapist can teach the patient how to speak more clearly to be better understood. As ALS progresses, the patient may learn to use devices such as speech synthesizers and computers to communicate.

Assistive Devices

Just as with physical therapy, assistive devices can help the patient maintain as much mobility as possible. Braces can support weakened muscles in the limbs. Canes, walkers and wheelchairs also can help with mobility.

As ALS weakens muscles used to breathe, the patient may need a ventilator (breathing machine), initially while sleeping and eventually full time. Frequently, patients may use BiPAP (Bilevel positive airway pressure) to assist with ventilation, usually at night to begin. Patients and their family should discuss with their physician the extent of ventilator use.

Nutritional Support

A nutritionist can advise the patient who has ALS and caregivers regarding foods that are nutritious but easy to swallow, helping the patient avoid choking or accidentally inhaling foods or liquids into the lungs. As ALS progresses, the patient will have a feeding tube inserted into the stomach for nutrition.

Mental Health Care

During the disease progression, ALS does not impair the patient's mind, personality, intelligence or memory, nor does it affect the person's ability to see, smell, taste, hear or recognize touch. As a result, the person is usually aware of progressive loss of function, and can become anxious and depressed, both of which can be treated with medication and counseling.

Family Support

Family members of people who have ALS need help in coping with the disease and its challenges. Mayo Clinic offers various resources, education and information and will also help family members connect with local ALS support groups.

Coordination with Primary Care Physician

Mayo Clinic coordinates treatment and follow-up care for ALS with the patient's primary care or local physician.