All About Lou Gehrig's Disease

ALS (amytrophic lateral sclerosis) or Lou Gehrig’s disease is a degenerative medical condition which affects the brain as well as the spinal cord. It leads to loss of control of the voluntary muscles of the body. The parts most often affected are the nerves that control the speech, swallowing, and limb movements. There is no cure.

Every year, there are about 5,000 to 6,000 individuals in the United States alone who are diagnosed with this medical condition. An estimated 20,000 to 30,000 individuals in America alone are living with this disorder without actually knowing that they have it. ALS does not discriminate, and can affect all racial, social, and economic groups. 

Causes of ALS

This medical condition is classified into two categories, sporadic and familial. Most cases are sporadic, which means there is no specific cause. In five to ten percent of cases, genetics has been identified as the only factor leading to this illness. Other causes of this illness have not been well understood. Below are certain factors that researchers believe may contribute to ALS:

• The response from the immune system which can tend to target the motor neurons
• Free radical damage
• Possible cause of an imbalance in glutamate, which is a chemical messenger
• Inside the nerve cells there can be possibility of buildup of abnormal proteins

Smoking, exposure to lead, and being part of military service have been identified as potential risk factors.

Symptoms

Symptoms of ALS depend on exactly which of the areas of the nervous system have been affected, so it tends to vary from individual to individual. Any damage caused to the medulla specifically can lead to:

• Hoarseness
• Slurred speech
• Production of excess saliva
• Difficulty swallowing
• Difficulty breathing
• Tongue atrophy
• The individual also undergoes emotional lability. This symptom can be characterized by an increase in emotional reactions like crying or laughing.

The corticospinal tract sends signals from the brain to the spinal cord. In ALS, this tract is damage, which leads to limb weakness. Any kind of degeneration to the anterior horn (front of the spinal cord) could lead to:

• Twitching in the muscles
• Flaccid weakness or limp muscles
• Wasting away of the muscle
• Weakness in the diaphragm or other respiratory muscles can lead to breathing problems

Early symptoms can include newfound difficulty in climbing stairs or sitting down. Early symptoms are mostly found in specific parts of the body or while performing certain actions. The symptoms also tend to become asymmetrical. As the illness progresses, symptoms generally start to spread to both the sides of the body. 

ALS can lead to mental and emotional symptoms as well. Many behavioral changes can occur without any kind of mental decline. Slowed thinking is said to be the most common of the cognitive symptoms in ALS sufferers. Degeneration of the cells in the frontal lobe is also known to occur in ALS-related dementia. When the individual has a family history of dementia, it can lead to ALS-related dementia as well.

ALS risk factors

Symptoms usually start to appear mostly between the age of 50 years and 60 years. However, symptoms can appear earlier as well. ALS is much more common in males than females.

Diagnosis

Most cases of ALS are diagnosed by a neurologist; however, there are no specific diagnostic tests. The exact process of establishing a correct diagnosis can take months. The doctor will consider any instances of progressive neuromuscular decline. To reach diagnosis, a doctor may see if he or she observes:

• Muscle wasting
• Twitching of the muscles
• Cramps caused in the muscles
• Weakness in the muscles
• Muscle contractions

But these symptoms are not exclusive to ALS since they can be caused by a varied number of other medical conditions. The doctor's main task is to rule out the possibility of any other health conditions. This is carried out with a varied number of diagnosis tests which can include:

• Blood tests to evaluate the health of the individual in general 
• EMG to evaluate any kind of electrical activity of the muscles
• Nerve conduction study
• MRI can show the part of the nervous system that has been impacted
• Genetic testing when applicable

Treatment

An occupational therapist, a psychiatrist, a neurologist, a well-trained nutritionist, a social worker, gastroenterologist, respiratory therapist, mental healthcare professional, and a speech therapist could all make up an ALS care team.

Medications

Currently, Riluzole or Rilutek is the only approved form of drug for treating ALS. This medication can prolong the life of the individual for several months, but it does not eliminate the symptoms of this disease entirely.

There are other forms of medications that can be used for symptom management, including:

• Neurodex, a combination of Vitamins such as B12, B1 and B6. This is mostly for treating emotional symptoms.
• Bisulphate, diazepam, quinine bisulphate, and baclofen can treat muscle spasms.
• NSAIDs or nonsteroidal anti-inflammatory drugs such as antidepressants, anticonvulsants, as well as morphine can be used to manage pain.

Other medications may include:

• Creatine
• Coenzyme Q10
• COX-2 inhibitors
• Minocycline

Be sure to speak with your doctor if you have questions about any medication.