What's the treatment for amyotrophic lateral sclerosis?
There is no cure for amyotrophic lateral sclerosis (ALS). Treatment focuses on keeping the person as strong and independent as possible, providing emotional support as disability increases, and preventing complications of the disease.
Physical therapy and occupational therapy may be helpful in maintaining strength and function and making the most of the person's remaining abilities. Speech therapy can help maintain the person's ability to communicate as speaking problems
develop. A physical therapist works with the patient and family to implement exercise and stretching programs to maintain strength and range of motion, and to promote general health. Swimming may be a good choice for people with amyotrophic lateral sclerosis, as it provides a low-impact workout to most muscle groups. One result of chronic inactivity is contracture, or muscle shortening. Contractures limit a person's range of motion, and are often painful. Regular stretching can prevent contracture. Several drugs are available to reduce cramping, a common complaint in amyotrophic lateral sclerosis.
An occupational therapist can help design solutions to movement and coordination problems, and provide advice on adaptive devices and home modifications. Speech and swallowing difficulties can be minimized or delayed through training provided by a speech-language pathologist. This specialist can also provide advice on communication aids, including computer-assisted devices and simpler word boards. Nutritional advice can be provided by a nutritionist. A person with amyotrophic lateral sclerosis often needs softer foods to prevent jaw exhaustion or choking. Later in the disease, nutrition may be provided by a gastrostomy tube inserted into the stomach.
The remainder of medical treatment is focused on relieving symptoms, maintaining function for as long as possible, and coping with loss of function. To help manage the symptoms of amyotrophic lateral sclerosis, mechanical devices, such as dressing aids and special utensils for eating, are available to make self-care easier. A cane or walker also may be helpful for patients who have difficulty walking. Patients should consider the option of using a mechanical respirator if they become unable to breathe on their own. Although artificial ventilation can help some patients survive for years, many patients choose not to be kept alive in a state of total paralysis, unable to communicate except with eye movements. Patients with amyotrophic lateral sclerosis should discuss this issue with their doctors early in the illness, so that the important and difficult decisions about emergency resuscitation can be made according to the patient's wishes in the event of life-threatening breathing problems.
Mechanical ventilation may be used when breathing becomes too difficult. Modern mechanical ventilators are small and portable, allowing a person with amyotrophic lateral sclerosis to maintain the maximum level of function and mobility. Ventilation may be administered through a mouth or nose piece, or through a tracheostomy tube. This tube is inserted through a small hole made in the windpipe. In addition to providing direct access to the airway, the tube also decreases aspiration. While many people with rapidly progressing amyotrophic lateral sclerosis choose not to use ventilators for lengthy periods, they are increasingly used to prolong life for a short time.
The progressive nature of amyotrophic lateral sclerosis means that most patients will eventually require full-time nursing care. This care is often provided by the spouse or other family member. While the skills involved are not difficult to learn, the physical and emotional burden of care can be overwhelming. Caregivers need to recognize and provide for their own needs as well as those of the patient, to prevent depression, burnout, and bitterness.