Therapeutic synergy: Benefits of a multifaceted ALS treatment strategy

Last updated June 17, 2024, by Lindsey Shapiro, PhD
Fact-checked by Ines Martins, PhD

The best way to manage amyotrophic lateral sclerosis (ALS) is through a multidisciplinary care plan tailored to a person’s specific medical needs.

This holistic approach involves combinations of ALS disease-modifying medications, treatments to manage ALS symptoms, and supportive care therapies.

Because there isn’t yet a cure for the progressive neurodegenerative disease, ALS treatment focuses on slowing down the disease and maintaining the best quality of life for as long as possible.

Medications for ALS

ALS symptoms are caused by the progressive loss of motor neurons, which are specialized nerve cells involved in voluntary muscle control.

Approved ALS therapies work to prevent or slow damage to motor neurons. In doing so, these treatments help maintain functional abilities, such as walking, swallowing, speaking, and breathing, for a longer period of time.

Available ALS treatment options include:

Riluzole, which works to reduce a signaling molecule called glutamate that’s believed to overstimulate and damage nerve cells in ALS. The medication is available as oral tablets (Rilutek and generics), a film that dissolves on the tongue (Exservan), or a liquid suspension (Tiglutik).
Edaravone, which works by reducing oxidative stress, a type of cellular damage that contributes to nerve cell death in ALS. It’s available for infusion into the bloodstream (Radicava) and as an oral liquid suspension (Radicava ORS).
Qalsody (tofersen), which aims to prevent the SOD1 protein from accumulating to toxic levels and damaging nerve cells in people with certain ALS genetic mutations. It’s administered via spinal canal injections, called an intrathecal injection.

Emerging evidence suggests combining multiple ALS therapies may offer greater benefits than a single medication does. But because there aren’t formal guidelines recommending this approach yet, you should discuss the potential benefits and risks of the various treatments with your doctor to decide the best course of action.

While ALS therapies can slow disease progression, they generally do not address symptoms you might already be experiencing. Still, there are medications not specifically approved for ALS that doctors can prescribe to manage these symptoms. Theses might include:

treatments for relieving muscle spasticity or cramps
medications reducing saliva production for those with swallowing difficulties
mood stabilizing treatments for depression, anxiety, or pseudobulbar affect
mucus-thinning therapies to facilitate mucus clearance when the muscles involved in coughing are weak.

Beyond medication: Supportive therapies

There are many supportive care approaches for ALS that help preserve function and improve overall well-being and quality of life.

The specific combination of supportive approaches should be tailored to each person’s unique care needs and goals. Care strategies also should be adapted over time as your needs and symptoms change.

Navigating the complexities of an ALS treatment plan can be challenging. It is crucial to regularly communicate with your healthcare team as they put together and adjust your ALS treatment plan to meet your needs and support your overall well-being.

Physical and occupational therapy

Both physical therapy and occupational therapy are highly recommended to help maintain your independence for as long as possible.

Physical therapy for ALS involves tailored exercises to help preserve muscle strength and mobility. A variety of exercises can be beneficial, including those that boost flexibility and strength or improve heart and lung health.

A physical therapist can show you the most effective and safe exercises for your situation and adapt these exercises over time as your needs change.

Occupational therapy focuses more broadly on helping people with ALS navigate daily life. The occupational therapist will assess your challenges at home, work, or school and suggest strategies to manage them, which may include using assistive technology or making home modifications.

People with ALS often rely on caregivers for daily assistance. An occupational therapist can also teach caregivers techniques for tasks such as dressing or toileting to ensure effective and compassionate care.

Speech and respiratory therapy

As muscle weakness progresses, it is common for people with ALS to experience speech difficulties, called dysarthria, and breathing problems.

The goal of speech therapy is to facilitate effective communication at every stage of the disease. This might involve customized exercises and strategies that help a person speak more clearly or communication devices to assist when speech is no longer possible. Speech therapists also can suggest strategies for managing swallowing difficulties, called dysphagia, caused by ALS.

A respiratory therapist is also commonly part of the multidisciplinary care team. They evaluate breathing and respiratory muscle strength and implement strategies to improve lung function and make breathing easier. They also may suggest interventions and equipment to assist with breathing when it is no longer possible to do independently.

Nutritional support

Due to weakness in the muscles involved in chewing, swallowing, and digestion, people with ALS often experience malnutrition and weight loss over time.

Several healthcare providers, including occupational and speech therapists, can help manage swallowing difficulties as a way of improving nutritional status. They may suggest strategies such as diet modifications (e.g., cutting food into smaller bites) or changes in eating habits (e.g., eating more slowly or sitting upright) to facilitate food intake.

Nutritionists or dietitians also may work with people with ALS and their caregivers in putting together an ALS diet that maintains nutritional status and prevents weight loss. When eating by mouth becomes too challenging, healthcare providers will discuss the potential need for a feeding tube to deliver nutrients directly to the stomach.

Adaptive equipment

There are many assistive equipment or adaptation options that help make living with ALS easier. These include:

mobility aids, such as canes, braces, walkers, and wheelchairs
communication aids, including text-to-speech devices, eye gaze software, or other alternative communication devices
breathing aids, such as noninvasive ventilation support, cough assist machines, mechanical ventilators, and breathing tubes
home accommodations, including ramps or stair lifts to help with getting around or smart-home electronics with voice activated controls
adaptive clothing with features such as elastic waists, magnetic buttons, and Velcro closures to make dressing easier
adaptive eating utensils and plates or bowls with higher sides to make eating easier.

Emotional and psychological support

Dealing with a serious and life-threatening disease like ALS can be emotionally challenging. As you process the diagnosis and adjust to life with ALS, you may experience a range of emotions, including anger, fear, grief, and apathy. Anxiety and depression are also common.

Therapy and counseling are an important part of ALS care. It allows you to give voice to all you are feeling while also learning coping strategies for dealing with the emotional and physical changes.

Support groups where people with ALS can talk with others who are going through similar experiences can offer a sense of community and help a person feel less alone. You might also hear practical advice for living with ALS.

Support is essential not only for those with ALS but also for their caregivers and family members, who are also dealing with a significant emotional burden. Care partners can greatly benefit from professional therapy and support groups.

Several organizations such as the ALS Association, I AM ALS, and the Les Turner ALS Foundation offer support groups for people affected by ALS, including patients, caregivers, and loved ones. There also are support groups for those who have lost someone to ALS.

The ALS News Today website also has information, support, and resources for people living with ALS. You can participate in forums to connect with others, and learn from the experiences of other patients and caregivers through our columns.

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.