Amyotrophic lateral sclerosis (ALS) is a disease characterized by the progressive loss of motor neurons, or the nerve cells involved in the control of the voluntary muscles. This leads to problems controlling muscles, which causes them to gradually weaken. As the disease progresses, patients usually find everyday tasks, such as walking and eating, gradually more difficult. 

Current treatments for ALS cannot reverse the damage caused by the disease or provide a cure, but they can slow the deterioration in function, prevent complications, and increase the comfort and independence of patients.

Approved ALS treatments

There are currently two treatments approved by the U.S. Food and Drug Administration for the treatment of ALS: Rilutek (riluzole) and Radicava (edavarone).

Rilutek was approved by the FDA in 1995 and has also been approved for marketing in many other countries, including Canada, Australia, and across Europe.

Rilutek is thought to interfere with the activity of glutamate, one of the chemical messengers that transmit signals between nerve cells. Too much glutamate in the brain and spinal cord can be toxic, as is the case with ALS.

The medication is taken by mouth and may cause adverse effects such as dizziness, gastrointestinal symptoms, and liver function changes.

Radicava was approved by the FDA in 2017 and by Health Canada in 2018. The treatment is currently only available in the U.S, Canada, Japan, and South Korea but it is also under consideration by the European Medicines Agency.

Radicava is thought to counteract the excessive oxidative stress seen in ALS. When taken over a six-month period, it has been shown to slow the rate of decline in ALS patients compared with a placebo. It is administered by infusion into a vein, typically for 10 to 14 days in a row, once a month. Side effects may include walking problems, bruising, and headaches. Serious allergic reactions to the sodium bisulfite in the formulation can also occur.

Symptomatic ALS treatments

There are other medications aimed at some of the specific symptoms of ALS. For example, muscle relaxants such as baclofen or diazepam may be prescribed to treat muscle cramps, spasms, and spasticity, and gabapentin can help control pain.

Pooling of saliva in the mouth due to difficulty swallowing can also be treated with medicines such as Elavil (amitriptyline), trihexyphenidyl, Scopaderm (scopolamine patch), or the more potent Robinul (glycopyrrolate)

Medications may also be required for the treatment of constipation, fatigue, depression, difficulty sleeping, and pseudobulbar affect, which is uncontrolled outbursts of laughing or crying.

Non-drug therapies

Non-drug therapies are an essential part of the management of ALS. These include lifestyle changes such as eating easy-to-swallow foods, which is advised especially in the early stages of the disease. As the condition progresses, however, a feeding tube may be required to reduce the risk of choking.

Physiotherapy to tackle pain and mobility and the use of equipment such as braces or a wheelchair can help prolong independence.

Occupational therapists can also provide advice regarding adaptations in the home.

Since the muscles involved in speech are affected, speech therapy can help ALS patients make themselves understood and explore other methods of communication including computerized voice synthesizers.

When breathing becomes more difficult, equipment may be required at night. In the later stages of the disease, a ventilator attached to a breathing tube inserted into the windpipe may be necessary.

***

ALS News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.