Amyotrophic Lateral Sclerosis (ALS)
Treatment Overview
Although there is no cure for amyotrophic lateral sclerosis (ALS), treatment can help you maintain strength and independence, manage symptoms, and avoid complications for as long as possible. Treatment also focuses on providing emotional support as your disability increases.
Physical therapy and occupational therapy may help you maintain strength and function and make the most of your remaining abilities. Speech therapy can help you maintain your ability to communicate after speaking problems begin.
Medicines may be used to relieve symptoms and make you more comfortable. These include:
- Baclofen (Lioresal), tizanidine (Zanaflex), dantrolene (Dantrium), or benzodiazepines such as diazepam (Valium), to relieve muscle stiffness, spasms, and twitching.
- Quinine, phenytoin sodium (Dilantin), benzodiazepines, or gabapentin to relieve muscle cramps.
- Morphine, to help with breathing problems (dyspnea). Antianxiety medicines such as diazepam or lorazepam may be helpful in relieving anxiety caused by breathing problems. The American Academy of Neurology also considers acupuncture a useful option for breathing problems when used in addition to medicine or breathing devices.5
- Antidepressant medicines, to help with depression, sleeplessness, poor appetite, or fatigue, and to decrease the production of saliva (which may be helpful if you have trouble with the muscles that control swallowing).
- Pain relievers, to reduce muscle pain, which sometimes develops late in the course of the disease.
If you are having problems getting enough food or taking medicine, a tube can be inserted through the skin into the stomach (percutaneous endoscopic gastrostomy, or PEG). The tube provides an easier way to get adequate nutrition and take medicines.
Breathing devices (ventilators) may be needed as the muscles of the chest become affected. Initially, extra oxygen can be given through a nasal cannula, a flexible plastic tube that is placed in the nostrils. For people who have mild breathing problems, nonsurgical forms of ventilation may be used. These include bilevel positive airway pressure (BiPAP) and noninvasive positive pressure ventilation (NPPV), which deliver air or extra oxygen through a face mask. However, in some cases, an opening in the neck leading to the windpipe (tracheostomy) may have to be created and oxygen delivered through a tube in the opening.
At first, breathing devices may be needed only part of the time, such as when you are sleeping. As the disease and breathing problems get worse, you may need to be on a breathing machine all the time.
Riluzole
A medicine called riluzole (Rilutek) may prolong survival by about 2 months.4 It is not known exactly how the medicine works, but it may slow the release of certain brain chemicals (neurotransmitters) that are believed to play a role in ALS. Riluzole is the only medicine approved for the treatment of ALS.
There are some disadvantages to taking riluzole. Although it has been shown to prolong survival for about 2 months, it does not improve symptoms or quality of life in ways that people with ALS, their caregivers, or their doctors have been able to detect. Most people tolerate riluzole very well, but it can cause side effects, including nausea, vomiting, weakness, dizziness, and coughing. Because riluzole can cause liver problems, people taking the drug need to have their liver checked on a regular basis. Treatment with riluzole is also expensive, and it may not help some people who have certain forms of ALS.
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| Author: | Monica Rhodes | Last Updated: September 7, 2006 |
| Medical Review: | Adam Husney, MD - Family Medicine Colin Chalk, MD, CM, FRCPC - Neurology | |
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| Topic Contents | |
| Topic Overview | |
| Symptoms | |
| Exams and Tests | |
 | Treatment Overview |
| Home Treatment | |
| Other Places To Get Help | |
| References | |
| Credits | |