Treatment Of Amyotrophic Lateral Sclerosis (ALS)

So far there is no medicine that can cure ALS, only reduce its progression

There are few medications to treat Amyotrophic Lateral Sclerosis (ALS). These few drugs help to reduce the progression of the disease and prolong the survival of the patient, but they are not capable of reversing the disease.

What is Amyotrophic Lateral Sclerosis (ALS)?

Also known as “Lou Gehrig’s disease,” ALS is a chronic, degenerative disease of the central nervous system (CNS). It is characterized by the progressive death of neurons that control voluntary muscles. The mean age of onset of the disease is between 55 and 65 years.

A family history of ALS has been observed in 5-10% of cases. The neurodegenerative nature of this disease is evidenced by the gradual worsening of symptoms. The mean duration of the disease is 20 months to 48 months with a range of 2 years to 5 years. About 20% of those affected survive 5 years and only 10% can survive 10 years or more. In general, 50% of patients die in the first 3 years from the onset of the condition, although it depends on the case.

First, ALS impairs the voluntary movement of the upper and lower extremities. Later, swallowing difficulties and even paralysis appear. These symptoms vary from person to person depending on the part of the brain affected. Quickly, there is a worsening of the individual’s quality of life, which ends up becoming dependent.

Treatment of Amyotrophic Lateral Sclerosis

Currently, there are two drugs approved for the treatment of ALS:

• Riluzole (Rilutek®). Glutamate has been found elevated in ALS patients. Well, this drug inhibits the release of glutamate by neurons in the CNS.

Riluzole, in turn, interferes with the effects of other excitatory amino acids and thus slows the progression of the disease. Among its most common side effects are: dizziness, gastrointestinal conditions and changes in liver function. It is advisable to monitor them at the beginning of treatment.

• Edaravone (Radicava®). In 2017, the FDA approved the use of this drug, which has been shown to reduce the daily deterioration related to ALS. The drug is administered intravenously. And, among its side effects, the following stand out:
  • Urticaria
  • Bruising
  • Inflammation
  • Difficulty breathing
  • Gait disturbances

Indirectly, numerous groups of drugs aimed at alleviating the symptoms of the disease will also form part of the therapy . Among them, we can mention muscle relaxants, laxatives, analgesics, hypnotics and antidepressants.

Non-pharmacological approach to ALS

As we have seen, there is no treatment that can cure Amyotrophic Lateral Sclerosis. The drugs mentioned above help to combat symptoms such as muscle cramps or sleep disturbances. This requires a very complete symptomatic approach.

However, correct multidisciplinary care improves the quality of life and survival of patients. Therefore, this team must be made up of:

• Neurologists. They will analyze the progress or not of the disease.
• Physiotherapists. They are responsible for arranging muscle strengthening programs, coordinating flexibility exercises and stretching with which they will try to avoid muscle atrophy and weakening typical of this condition. Hydrotherapy is also often used.
• Psychologists. Maintaining an adequate emotional state is important since ALS frequently leads to the appearance of psychological disturbances.
• Speech therapists. They should intervene from the beginning of the disease, advising and educating both the patient and the educator on all issues of speech.

• Nurses and nutritionists. They are in charge of advising on eating habits. Its help is aimed at maintaining the patient’s weight and avoiding bronchoaspirations.
• Occupational therapists. They will try to improve the physical environment of the patient, facilitating their mobility and making their day-to-day easier.

The planning of the rehabilitation program must be individualized, taking into account the characteristics of the ALS of each patient.

Treatment of ALS with stem cells

The application of stem cells to the treatment of Amyotrophic Lateral Sclerosis is very novel. In the initial stages of the disease, the administration of stem cells stabilizes the brain lesions caused by ALS.

In more advanced stages, this treatment is ineffective. Bone marrow transplantation is only possible if there is a compatible donor. However, the mortality associated with this procedure ranges between 15% and 20%.

Autotransplantation could also be chosen. It consists of administering stem cells from the individual himself. This variant would greatly reduce the risk of mortality, although it is not yet sufficiently developed. It is believed that it will be a good alternative in the future.