The drug riluzole may be recommended to help slow the progression of ALS; it works in some people by possibly reducing the levels of the neurotransmitter glutamate in the brain.
Exercise and lifestyle modifications are critical to managing the symptom of muscle weakness.
Regular, individualized exercise programs (never to the point of exhaustion) have been shown to slow muscle wasting in people with ALS and minimize spasticity. Recommended exercises include stationary bicycle riding, walking on even surfaces and water exercises (but not weightlifting or resistance training).
Adaptive devices designed for specific limb weakness can help improve a patient’s independence. For example, an ankle-foot orthotic can help to minimize falls and maximize endurance. Splints can be used to increase grip strength and improve finger dexterity and button hooks, zipper pulls and larger-handled utensils can make daily tasks easier.
Modifying bathrooms and other sites in the home, as well as using walking devices such as cane, walkers and wheelchairs, can help eliminate falls due to muscle weakness.
Muscle weakness can place excessive stress on joints, as can the pressure from prolonged sitting or reclining. Anti-inflammatory medications, frequently changing position, stretching exercises and specialty mattresses can help reduce pain.
Medication is also an option to relieve some of the symptoms of ALS:
- Cramps and spasms
- Fatigue and general muscle pain
- Problems sleeping
- Uncontrollable outbursts of laughing or crying (known as pseudobulbaraffect)
- Increased saliva or phlegm
Several therapy options may be of help in managing ALS:
- Physical therapy to help maintain muscle strength and flexibility and help the patient transition to devices to help with mobility
- Occupational therapy to help the patient compensate for hand and arm weakness and to modify the home
- Speech therapy to help make speech better understood and to introduce devices to aid in communication
- Breathing care to introduce devices to help the patient breathe as muscles become weaker
Slurred speech in ALS patients can be frustrating, but numerous devices can help a person communicate (from computer tablets to a simple “magic” slate erasable writing pad). A speech pathologist can assist the patient to find the best option to achieve the goal.
Therapy for respiratory dysfunction is intended to provide general breathing support:
- Careful monitoring of breathing
- Promptly treating all respiratory infections
- Providing supplemental oxygen if blood oxygen levels are low
- Minimizing the chances of aspiration in patients with swallowing difficulties
- Providing drugs to help decrease excessive saliva or phlegm
- Using suction devices to remove excess secretions
Breathing exercises may help strength diaphragm muscles. Non-invasive machine ventilation (for example, a CPAP machine) can improve breathing.
ALS patients may be affected with pseudobulbar affect, inappropriate crying or laughing outbursts associated with upper motor neuron dysfunction which is not an indication of a psychological problem. Medication can help alleviate this condition.
Our team will also assist the patient in engaging nutritional experts to provide foods that meet nutritional needs and are easy to swallow. Generally, no change in diet is necessary with ALS, but swallowing difficulties can make it a challenge to both nourish the body with a balanced meal and to maintain a healthy weight. Some strategies to help patients meet dietary goals include more frequent and smaller meals, as well as the inclusion of high-protein, high-calorie snacks between meals. The addition of a multivitamin and fruits and vegetables (in fresh or juice form) can make it easier to get the required vitamins and minerals.
Since there is a possibility that oxidative stress may contribute to ALS, increasing the amounts of antioxidants such as vitamins E, C and beta carotene may be beneficial. A recent experiment using genetically engineered mice with the same mutated gene that occurs in people with familial ALS shows that adding vitamin E to the food delays the onset of motor neuron loss and oxidative damage and slows progression of the condition, but does not prolong survival.