ALS Disease

Amyotrophic lateral sclerosis, abbreviated as ALS, is a disorder that affects the brain and spinal cord and causes damage to nerve cells. As this disease develops, the individual’s voluntary muscle control weakens and continues to deteriorate over time. Speaking, swallowing and walking are among the voluntary muscle movements that may be affected as a result of ALS. Although there is no treatment method developed for ALS yet, various studies have shown that there are various treatment approaches that can alleviate complaints and help individuals live a longer life. Lou Gehrig, a famous baseball player in the 1930s, is one of the individuals who suffered from this disorder. For this reason, when talking about ALS in some sources, it can be seen that it is also referred to as Lou Gehrig’s disease. You can follow the rest of the article for other topics you are curious about about ALS disease.

What is ALS Disease?

ALS disease is a damaging disorder that targets cells in nervous system structures such as the brain and spinal cord. With the onset of the disease, muscle control gradually disappears. Although it has not yet been fully revealed what causes this disease, there is familial transmission in a small portion of the patient group.

ALS disease initially manifests itself with symptoms such as muscle twitching, weakness in the arms and legs, difficulty swallowing and difficulty speaking. The disorder worsens over time, making it difficult for the individual to move, speak, eat and breathe.

What are the symptoms of ALS disease?

Symptoms of ALS disease vary from person to person. The symptoms that occur may also differ depending on which nerve cell is affected. ALS, which usually manifests itself with muscle weakness in the beginning, gradually progresses and gets worse over time. Some of the complaints that may occur other than this symptom can be summarized as follows:

• Difficulty in walking and performing other daily activities,
• Frequent trips and falls,
• Weakness in legs, feet and ankles,
• Weakness and clumsiness in the hands,
• Difficulty in speaking, difficulty swallowing,
• Weakness due to cramps and twitching in the muscles,
• Having untimely laughing, crying or yawning attacks,
• Cognitive and behavioral changes.

ALS disease is a disease that usually begins with involvement of the hands and feet. It starts on one side of the body and progresses to the other side. As the number of dead nerve cells increases, muscle weakness and the severity of complaints also increase. This condition progresses over time to the inability to perform vital functions such as chewing, speaking, swallowing and breathing.

In the early stages of ALS, there are usually no complaints of pain. In fact, generally speaking, pain is not a very common symptom in the advanced stages of ALS. At the same time, since the muscles that enable the bladder to work are rarely affected, complaints such as urinary incontinence are not common. Sensory functions such as taste, smell, touch and hearing are also generally found to be preserved.

What Causes ALS?

According to Disease Control and Prevention (CDC) data, 2-5 out of every 100,000 people in the world may be affected by this disease (3). Some risk factors that may be effective in the emergence of the disease can be summarized as follows:

• Gender: ALS is a disease that is more common in men than women, even if it is mild. The difference in the incidence of the disease between these two genders disappears after the age of 70.
• Age: Symptoms related to ALS usually begin to appear in the late 50s or early 60s. It should not be forgotten that some individuals may experience symptoms outside these age groups.
• I: Individuals with white skin color may be more likely to develop ALS.

ALS disease is generally divided into two subtypes: sporadic and familial. Sporadic ALS cases are the subtype that can occur randomly in any individual and are estimated to cover approximately 90-95% of all cases (1). There are no clearly defined specific risk factors or causes for sporadic cases.

Familial transmission can be detected in approximately 5-10% of ALS cases (1). In this patient group, defined as familial (familial) ALS cases, various complaints may occur in early adulthood, although rare.

How is ALS Disease Diagnosed?

In the diagnostic approach to ALS disease, taking the person’s complaints, physical examination and using various tests can be used. Currently, there is no test that can diagnose or exclude this disease on its own. It is important to exclude other diseases that may cause similar complaints in ALS, which can be diagnosed through various neurological evaluations and examinations. Various tests that can be applied for this purpose are as follows:

• Evaluation of medical history: It refers to questioning the individual who is suspected of having the disease about various other health problems and the medications he/she uses, if any.
• Neurological examination: At this stage, the patient’s reflexes and muscle strength are evaluated. By repeating the examination, it becomes clear what the status of the complaints is and whether they are progressing. While sensory nerve functions were found to be preserved in ALS patients, reflexes began to decrease in the initial stages of the early stage. As the disease progresses, muscle weakness becomes quite evident.
• Nerve conduction studies: With this test, the level of communication between the person’s nerves and muscles is evaluated.
• Electromyography: It is the evaluation of the electrical activity occurring in muscle fibers.
• Lumbar puncture: In lumbar puncture, which is performed by advancing a needle into the spinal canal, a fluid sample is taken to determine the level of inflammation, if any.
• MRI: Magnetic resonance imaging allows detailed imaging of nerve structures such as the brain and spinal cord.
• Muscle biopsy: Taking samples from muscle tissue is important for detecting diseases that are not ALS but may cause similar complaints. In this test, a sample of muscle tissue is taken and sent to the laboratory for examination by pathologists.
• Laboratory tests: Laboratory tests performed by taking blood and urine samples evaluate the presence of any infection or organ functions. These examinations can also be helpful in ruling out various other health problems.

What are the Treatment Methods for ALS Disease?

It is not possible to reverse nerve damage with the treatments applied in ALS disease, but it can contribute to alleviating the complaints and slowing the progression of the disease. Thanks to the treatment approach applied, individuals can be supported in their independence and ability to live their lives comfortably.

Medicines containing the active ingredient Riluzole are one of the drugs used in the treatment approach to ALS. This drug can increase the life expectancy of individuals by approximately ¼ (6). It is important to monitor liver functions regularly while using this drug, which may cause dizziness, liver problems and various side effects related to the digestive system. Apart from riluzole, drugs containing the active ingredient edaravone can also be prescribed by their physicians to individuals with ALS disease. This medicine generally has the feature of supporting daily activities. Bruising, headache and difficulty in walking are among the side effects that may occur while using this medicine. In addition to drug therapy, various supportive treatments are also included in the treatment approaches to ALS disease:

• Supporting breathing,
• Physical therapy practices,
• Functionality therapies,
• speech therapies,
• Providing appropriate nutritional support.

In addition to these practices, it is also very important to provide psychological and social support to individuals.

ALS is among the diseases that are difficult to diagnose. It can often be confused with multiple sclerosis or Parkinson’s disease, especially in its early stages. If you or your surroundings observe complaints about this disorder, which can be diagnosed through various examinations and neurological evaluations, it is recommended that you contact healthcare institutions and get support from specialist physicians. We wish you healthy days.