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Management of amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), has evolved rapidly in the last ten years and although still incurable, ALS is not untreatable. In this updated review we examined the evidence from two randomised trials, involving 54 participants in total, of non‐invasive ventilation (using a face or nasal mask and a small portable ventilator) in people ... more

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A.D.A.M. Medical Encyclopedia.

Amyotrophic lateral sclerosis

Lou Gehrig's disease; ALS; Upper and lower motor neuron disease; Motor neuron disease

Last reviewed: August 26, 2012.

Amyotrophic lateral sclerosis, or ALS, is a disease of the nerve cells in the brain and spinal cord that control voluntary muscle movement.

ALS is also known as Lou Gehrig's disease.

Causes, incidence, and risk factors

1 out of 10 cases of ALS are due to a genetic defect. The other times, the cause is unknown.

In ALS, nerve cells (neurons) waste away or die, and can no longer send messages to muscles. This eventually leads to muscle weakening, twitching, and an inability to move the arms, legs, and body. The condition slowly gets worse. When the muscles in the chest area stop working, it becomes hard or impossible to breathe.

ALS affects approximately 5 out of every 100,000 people worldwide.

There are no known risk factors, except for having a family member who has a hereditary form of the disease.

Symptoms

Symptoms usually do not develop until after age 50, but they can start in younger people. Persons with ALS have a loss of muscle strength and coordination that eventually gets worse and makes it impossible to do routine tasks such as going up steps, getting out of a chair, or swallowing.

Breathing or swallowing muscles may be the first muscles affected. As the disease gets worse, more muscle groups develop problems.

ALS does not affect the senses (sight, smell, taste, hearing, touch). It only rarely affects bladder or bowel function, eye movement, or a person's ability to think or reason.

Symptoms include:

  • Difficulty breathing
  • Difficulty swallowing
    • Choking easily
    • Drooling
    • Gagging
  • Head drop due to weakness of the neck muscles
  • Muscle contractions called fasciculations
  • Muscle weakness that slowly gets worse
    • Commonly involves one part of the body first, such as the arm or hand
    • Eventually leads to difficulty lifting, climbing stairs, and walking
  • Speech problems, such as a slow or abnormal speech pattern (slurring of words)
  • Voice changes, hoarseness
  • Weight loss

Signs and tests

The doctor or nurse will examine you and ask questions about your medical history and symptoms.

The physical exam may show: 

  • Weakness, often beginning in one area
  • Muscle tremors, spasms, twitching, or loss of muscle tissue 
  • Twitching of the tongue (common)
  • Abnormal reflexes
  • Stiff or clumsy walk
  • Increased reflexes at the joints
  • Difficulty controlling crying or laughing (sometimes called emotional incontinence)
  • Loss of gag reflex

Tests that may be done include:

  • Blood tests to rule out other conditions
  • Breathing test to see if lung muscles are affected
  • Cervical spine CT or MRI to be sure there is no disease or injury to the neck, which can mimic ALS
  • Electromyography to see which nerves or muscles do not work properly
  • Genetic testing, if there is a family history of ALS
  • Head CT or MRI to rule out other conditions
  • Swallowing studies
  • Spinal tap (lumbar puncture)

Treatment

There is no known cure for ALS. A medicine called riluzole helps slow down the symptoms and lets you live longer.

Treatments to control other symptoms include:

Physical therapy, rehabilitation, use of braces or a wheelchair, or other measures may be needed to help with muscle function and general health.

Choking is common. Patients may decide to have a tube placed into their stomach for feeding. This is called a gastrostomy.

A nutritionist is very important. Patients with ALS tend to lose weight. The illness itself increases the need for food and calories. At the same time, problems with swallowing make it hard to eat enough.

Breathing devices include machines that are used only at night, and constant mechanical ventilation.

Patients should discuss their wishes regarding artificial ventilation with their families and doctors.

Support Groups

Emotional support is vital in coping with the disorder, because mental functioning is not affected. Groups such as the ALS Association may be available to help people who are coping with the disorder.

Support for people who are caring for someone with ALS is also available, and may be very helpful.

See: ALS - support group

Expectations (prognosis)

Over time, people with ALS progressively lose the ability to function and care for themselves. Death often occurs within 3 - 5 years of diagnosis. About 1 in 4 patients survive for more than 5 years after diagnosis.

Complications

Calling your health care provider

Call your health care provider if:

  • You have symptoms of ALS, particularly if you have a family history of the disorder
  • You or someone else has been diagnosed with ALS and symptoms get worse or new symptoms develop

Increased difficulty swallowing, difficulty breathing, and episodes of apnea are symptoms that require immediate attention.

Prevention

You may want to see a genetic counselor if you have a family history of ALS.

References

  1. Murray B, Mitsumoto H. Disorders of upper and lower motor neurons. In: Daroff RB, Fenichel GM, Jankovic J, eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 74.
  2. Shaw PJ. Amyotrophic lateral sclerosis and other motor neuron diseases. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 418.

Review Date: 8/26/2012.

Reviewed by: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

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    Muscle cramps are common and can occur in a wide range of settings. Older adults and pregnant women commonly complain of leg cramps while they are resting, athletes can cramp when they are pushing the limits of their endurance, and some people develop muscle cramps as a symptom of other medical conditions. One potential treatment that is already being marketed to prevent muscle cramps is magnesium supplementation. Magnesium is a common mineral in our diets and extra oral supplements of this mineral are available either over the Internet or in health food stores and pharmacies (usually in the form of tablets or powders to be dissolved in water). We searched for all high quality published studies evaluating the effectiveness of magnesium to prevent muscle cramps and found four studies in older adults and three studies in pregnant women. There were no studies of people who cramp while exercising and no studies on people who cramp because of underlying medical problems. The four studies in older adults (a total of 322 participants including controls in cross‐over studies) collectively suggest that magnesium is unlikely to provide a meaningful benefit in reducing the frequency or severity of cramps in that population. We consider this evidence to be of moderate quality. In contrast, the three studies in pregnant women (202 participants) are collectively inconclusive since one study found benefit in reducing both cramp frequency and cramp pain while the other two found no benefit. More research on magnesium in pregnant women is needed; however, older adult cramp sufferers appear unlikely to benefit from this therapy. While we could not determine the rate of unwanted side effects, the study withdrawal rates and adverse event discussions suggest the treatment is well tolerated.
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