In amyotrophic lateral sclerosis (ALS), patients experience progressive muscle weakness and a decline in motor control due to the death of nerve cells in the central nervous system that control the voluntary muscles. This can result in the patient experiencing a range of symptoms, including difficulty walking, muscle cramps and twitches, slurred speech, breathing problems, and periods of uncontrollable laughing or crying.

No cure exists for ALS yet, but there are treatments that may slow the progression of the disease and a range of medications that can help ease its symptoms. As ALS can progress differently in each individual patient, the symptomatic therapies a patient is prescribed should be tailored to their needs. These also can be accompanied by non-drug therapies such as physiotherapy or breathing support, as necessary.

Treatment of muscle symptoms

ALS patients can experience painful muscle cramps, spasms, and spasticity. This may be treated with  medications that encourage muscles to relax, such as baclofen, diazepam, gabapentin, tizanidine, benzodiazepines, or dantrolene.

Recent clinical trials, published in the journal Neurology in 2016 and Muscle and Nerve in 2018, suggest that mexiletine also may be effective in reducing the frequency and effect of muscle cramps in ALS. Mexiletine is normally prescribed to treat irregular heartbeats under the brand name Mexitil.

Treatment for excessive saliva production

As the throat muscles weaken, some patients with ALS may struggle to swallow. This can result in saliva pooling in the mouth, leading to symptoms such as drooling and an increased risk of choking due to excess saliva. Medications to reduce saliva production may help reduce the risk of this occurring.

Examples include Elavil (amitriptyline)trihexyphenidylScopaderm (scopolamine patch), and Robinul (glycopyrrolate).

Treatment of pseudobulbar affect

Pseudobulbar affect (PBA) is a condition that causes uncontrollable episodes of crying or laughing, unrelated to the situation or the emotional state of the affected individual. In ALS, this can be a result of damage to areas of the brain involved in emotional control.

Nuedextra is a U.S. Food and Drug Administration (FDA)-approved medication to treat the symptoms of PBA. In some cases, antidepressants such as serotonin uptake receptor inhibitors (SSRIs) also may be helpful.

Treatments for other symptoms

ALS does not directly cause depression, but the impact of the disease on a patient’s life may result in depression or anxiety. This can be treated with antidepressants.

ALS also may be associated with constipation, which can be initially addressed by increasing fluid intake, changing diet, and exercising. However, if this does not help, options such as laxatives may be used.

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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.