Amyotrophic lateral sclerosis, or ALS, is a fatal nervous system disease that affects the motor neurons controlling voluntary muscles. Eventually, the patient becomes paralyzed and unable to swallow, speak or breathe. There is currently no cure for ALS, also called Lou Gehrig's disease, but treatment can improve quality of life and possibly lengthen the patient's lifespan following diagnosis.
Types
As of August 2010, Riluzole was the only drug specifically approved to treat ALS by the U.S. Food and Drug Administration. Physicians may prescribe other drugs to treat muscle cramping, insomnia, constipation, depression and pain. Medicines to dry excessive mouth secretions or phlegm may also be ordered. A ventilator may be used when breathing ability begins to fail, and a feeding tube may be needed when swallowing becomes difficult or unsafe, explains MayoClinic.com.
Benefits
Riluzole slows disease progression in some patients, according to a Practice Parameter Update published in Neurology. Other medications alleviate painful disease symptoms or improve quality of life by relieving insomnia and depression. Ventilator support allows the patient to maintain a healthy blood oxygen level, nourishing the brain and other organs. A feeding tube helps the ALS patient maintain a healthy body weight and receive adequate nutritional support.
Drawbacks
Like all medications, Riluzole has potential side effects, which include excessive tiredness, nausea and vomiting. Ventilator use leaves an individual susceptible to respiratory infection; if a tracheostomy--a surgical procedure that opens the trachea to allow air to travel toward the lungs via the ventilator tubing--is desired, the patient risks anesthesia, bleeding and infection complications. Feeding tubes have numerous complications. Depending on the type and placement of tube, they can slip out of place, require surgery, break off in the gastrointestinal tract or become clogged.
Considerations
Amyotrophic lateral sclerosis is a disease that requires careful management, particularly in the latter stages of the disease. Treatment decisions must be carefully considered by the physician and patient. Patients who seek aggressive care should be prepared for frequent physician visits and the possibility of home health or private duty nurses in the home. Support from family members or medical professionals is typically required during the latter stages of the illness.
Warning
Ventilator support becomes necessary for survival in end-stage ALS. It is critical that a caregiver--either a medical professional or trained family member or friend--monitor the ventilator around the clock once the patient cannot communicate or freely move on his own.
References
- "Neurology"; Practice Parameter Update: The Care of the Patient With Amyotrophic Lateral Sclerosis; R.G. Miller, M.D., et al.; 2009
- MayoClinic.com: Amyotrophic Lateral Sclerosis
- "2010 Lippincott's Nursing Drug Guide"; Amy M. Karch, R.N., M.S.; 2010
