This article discusses current medications and recent advances in the treatment of ALS.
The Stages of ALS
ALS progresses in stages. Early symptoms of ALS can include:
Muscle crampsTwitching in the tongue, arms, shoulders, or legsStiffnessDifficulty moving/muscle tightnessWeakness in the arms, legs, or neckDifficulty breathingSlurred speechNasal-sounding speechSwallowing difficultiesDifficulty chewing
As ALS progresses, individuals often begin to stumble and fall and have difficulty performing basic daily tasks such as getting dressed or writing.
In advanced stages, muscle weakness leads to an inability to speak, swallow, and walk. Individuals will require mechanical ventilation when the muscles used for breathing (diaphragm) stop working. People with this condition ultimately become wheelchair-dependent.
As ALS progresses, it will eventually lead to death.
Is There an ALS Cure?
There is no cure for ALS. Medications can help slow the progression of the disease, and therapies help individuals with the condition adapt to physical and emotional changes that occur.
King’s staging system: This system focuses on the number of regions in the body that are affected by the condition. Milano-Torina staging system (MiToS): This system tracks the body’s loss of function.
Medications
These three medications have been approved by the Food and Drug Administration (FDA) to help slow the progression of ALS:
Rilutek (riluzole): This medication decreases levels of glutamate (a neurotransmitter) to help reduce damage to motor neurons. Rilutek is available in pill form, but this medication is also available as thickened liquid (Tiglutik) or as a tablet dissolved on the tongue (Exservan). Radicava (edaravone): This medication is given by intravenous (IV) infusion, orally, or through a feeding tube; it helps slow functional decline for people with ALS. Relyvrio (sodium phenylbutyrate/taurursodiol): Approved in 2022, this medication is in powder form and taken by mixing with water. Relyvrio may lead to longer survival time for individuals with ALS.
Therapies
A variety of therapies can help individuals adapt to the physical and psychological challenges that occur with ALS.
Physical therapy: This therapy helps address muscle tightness and pain from ALS. Physical therapists help people with ALS maintain mobility as muscles become weaker. This often includes the use of assistive devices (such as a cane or walker) and choosing an appropriate wheelchair when the individual is no longer able to walk. Occupational therapy: This therapy helps individuals with ALS maintain independence with activities of daily living (ADLs). Occupational therapists teach people how to use adaptive equipment for tasks such as bathing, eating, dressing, and grooming. Speech therapy: ALS affects muscles throughout the body, including the head and neck. As a result, communication becomes difficult. Speech therapists help individuals with ALS learn to talk more clearly and to use alternate forms of communication once they lose the ability to speak. Speech therapists also address swallowing difficulties that develop from ALS. Respiratory therapy: Respiratory therapists help individuals with ALS learn to breathe and cough more effectively as muscles that perform these functions get weaker. When mechanical ventilation becomes necessary, respiratory therapists help people navigate their options. Psychotherapy: ALS affects all aspects of a person’s life, which can cause significant anxiety or depression. Psychotherapists and other mental health counselors can help individuals with ALS process the changes that occur with the condition.
New Advancements in ALS Treatment
Areas of focus for research on ALS include:
Potential cell defects that contribute to the breakdown of motor neurons Development of biomarkers (measurable substances) in the body that can help detect ALS and monitor progression of the disease Role of genetics in the development of ALS Stem cell therapy
Researchers also continue to perform clinical trials to study potential new medications that can be used to treat ALS. Individuals with ALS can join the National Amyotrophic Lateral Sclerosis (ALS) Registry to learn more about current research and how to donate biological materials (such as deoxyribonucleic acid (DNA), blood, or other tissues) to the National ALS Biorepository.
Summary
There is no cure for ALS, but several medications approved by the FDA can help slow the progression of the condition. Therapies help individuals with the condition adapt to the physical and emotional changes that occur with ALS. Researchers continue to study potential new medications and treatments for the disease.
