Sunday, 7 January 2018

Treatments For ALS Disease (Amyotrophic Lateral Sclerosis)

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Adaptive equipment can help people with ALS to stay mobile. ALS is a kind of MND. It attacks the nerve cells that are used in voluntary muscle actions, known as motor neurons. These are actions that we can control, such as those in the arms, face, and legs. Motor neurons are found in the brain and spinal cord. As ALS progresses, these cells degenerate and die. They stop sending messages to muscles. The brain can no longer control voluntary movement, and the muscles weaken and waste away.
As ALS progresses, it affects all the voluntary muscles. The person can no longer control their arms, face, and legs. In time, the inability to breathe unsupported can lead to respiratory failure.
Half of all people with ALS will live for 3 years or more after diagnosis, but some live for longer. Around 20 percent of people will live 5 years or more after diagnosis, 10 percent will live for 10 years or more, and 5 percent will live for 20 years.

Diagnosis
Amyotrophic lateral sclerosis (ALS) is difficult to diagnose early because it may mimic several other neurological diseases. Tests to rule out other conditions may include:
◾Magnetic resonance imaging (MRI) : Using radio waves and a powerful magnetic field, an MRI produces detailed images of your brain and spinal cord. An MRI can spot spinal cord tumors, herniated disks in your neck or other conditions that may be causing your symptoms.
◾Electromyography (EMG), which detects electrical energy in muscles
◾Nerve conduction study (NCS), which tests how well the nerves send signals

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◾Blood and urine tests : Analyzing samples of your blood and urine in the laboratory may help your doctor eliminate other possible causes of your signs and symptoms.
Spinal tap (lumbar puncture). Sometimes a specialist may remove a sample of your spinal fluid for analysis. A specialist inserts a small needle between two vertebrae in your lower back and removes a small amount of cerebrospinal fluid for testing in the laboratory.

These tests can help rule out peripheral
neuropathy, or peripheral nerve damage, and myopathy, or muscle disease. An MRI scan can detect other problems that could be causing symptoms, such as a spinal cord tumor or a herniated disk in the neck.
Further tests to rule out other conditions may
include blood and urine tests and a muscle biopsy. Medical problems that can produce similar symptoms to ALS include HIV, Lyme disease , multiple sclerosis (MS), the polio virus, and West Nile virus . If there are symptoms in both the upper and lower motor neurons, ALS may be present.
Upper motor neuron symptoms include stiffness and resistance to movement in the muscles and brisk reflexes. Lower motor neuron symptoms include weakness, muscle atrophy, and twitching.

Treatments
Riluzole (Rilutek) : This drug appears to slow the disease's progression in some people, perhaps by reducing levels of a chemical messenger in the brain (glutamate) that's often present in higher levels in people with ALS. Riluzole is taken as a pill and may cause side effects such as dizziness, gastrointestinal conditions and liver function changes.

Edaravone (Radicava) : The FDA approved edaravone in 2017 based on six-month clinical trial that showed it reduced the decline in daily functioning associated with ALS. The drug is given via intravenous infusion (typically 10-14 days in a row, once a month), and side effects may include bruising, gait disturbance, hives, swelling and shortness of breath.

Therapy
Occupational therapy : An occupational therapist can help you find ways to remain independent despite hand and arm weakness. Adaptive equipment can help you perform daily activities such as dressing, grooming, eating and bathing.
An occupational therapist can also help you modify your home to allow accessibility if you have trouble walking safely. Occupational therapists also have a good understanding of how assistive technology and computers can be used, even if your hands are weak.

Speech therapy is useful when ALS begins to make it harder to talk. Speech therapists can help by teaching adaptive techniques. Other methods of communication include writing and computer-based communications equipment.


Nutritional support is important, as difficulty with swallowing can make it hard to get enough nutrients. Nutritionists can advise on preparing nutritious meals that are easier to swallow. Suction devices and feeding tubes may help.



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Author: Richard Smith