Amyotrophic Lateral Sclerosis - Therapy

Amyotrophic Lateral Sclerosis - Therapy

Amyotrophic Lateral Sclerosis can not be healed, but patients with Amyotrophic Lateral Sclerosis can be treated, and they have to be treated.

The aim of therapy in Amyotrophic Lateral Sclerosis is to improve and stabilize strength, funcitoning and especially independence in activities of daily living. The best therapy can be obtained by an interdisciplinary team consisting of physicians, nurses, physiotherapists, occupational therapists, logopaedics, psychologists and social workers. Since a few years there are medical options, Riluzole is the first drug exhibiting an improvement of the course of the disease.

Amyotrophic Lateral Sclerosis - Medication

Riluzole

The first drug proving effectiveness under controlled conditions was riluzole. A mean extension of life duration of some months was documented in that study. It seems to be especially effective in patients with initial signs of dysarthria and dysphagia. In a recent retrospective study as well as in an open prospective study patients showed an increase of life duration of 21 or 12 months. It is recommended to prescribe this medication as early as possible in the course of the disease.

Creatine

Creatine is important in muscle energy metabolism. The mouse model of motor neuron disease showed an effectiveness of Creatine on survival of motor neurons. These results could not be reproduced in man.

Some athletes use it to get a better strength of their muscles. So patients tried it as well with the same purpose. The substance is to be taken with much fluid (2 litres per day), but not with coffee. In the first ten days of intake twice a day 4 grams are recommended, then twice a day 2 grams. Uptake of this substance into the muscle fibre is an active process. The activity of this process gets downregulated when there is much creatine circulating in the blood. So after three months of intake an interruption for one month is necessary. Then one has to start with a loading dose for ten days again. Before taking creatine one should consult the general practitioner wether there are any contraindications, especially in case of preexisting renal disease.

Vitamin E

Tocopherol (Vitamin E) is an antioxidative substance. It reduces the effect of metabolic products of oxygen (radicals) in cells. In high doses of 1000 mg per day a gain of life duration could not be noticed in Amyotrophic Lateral Sclerosis, but the progression from less severe to more severe stages seemed to be slowed.

Other substances

Some nerve growth factors were examined without success or presented intolerable side effects. Anabolic agents, antiviral medications, some hormones and immune suppressive drugs did not show any effect at all.

Amyotrophic Lateral Sclerosis - Physiotherapy

Weakness of muscles is the cause of most of the problems in Amyotrophic Lateral Sclerosis. Patients with Amyotrophic Lateral Sclerosis should train with low to moderate intensity, not aiming an increase of strength but stabilisation of present functions. According to the actual condition an increase of stamina and function may be aimed. Too intensive training can result in further weakness. Patients should be advised not to train until exhaustion. They should learn to recognize warning signs like marked weakness and muscle pain, especially continuing 24 to 48 hours after training or enhanced cramps.

Training with low to moderate aerobic exercise, e.g. walking, swimming and training with an ergometer, always dependent on the individual condition can be done. So staying power and performance of the cardiovascular system can be maintained.

Shortening of muscles has to be recognized and moderate stretching has to be done, especially in case of wheelchair dependency .

In individual cases orthotic devices can lead to better movement function. E.g. an ankle-foot orthosis can help walking without stumbling in case of weakness of foot elevators.

In the course of the disease muscles of respiration are involved. First symptoms may be sleep disturbances, morning headache and dyspnea on exertion. In the last fifteen years increasing knowledge in therapy of this condition was gained. Pulmonary function has to be be trained by physiotherapy. If this is not sufficient patients should be offered nasal ventilation, at first mainly used in the night.

Further aspects of physiotherapy are massage, thermotherapy, balneotherapy and electrotherapy. Their main issue is pain reduction and relaxation of tense muscles due to unphysiological use.

Amyotrophic Lateral Sclerosis - Occupational Therapy

Occupational therapy has the same approach as physiotherapy, the main focus lies on arm function and trunk control. A domain of occupational therapy is providing patients with assistive devices to support independence in daily living. When properly selected and designed, they can maintain independence and often increase safety, speed and acceptance. Simple assistive devices such as grab bars, reachers or sliding boards can help with gross positioning and activities. Clamp-On Raised Toilet Seat and safety frame may support toilet use.

Amyotrophic Lateral Sclerosis - Logopaedics

Disorders of speaking and swallowing are the main subjects of logopaedia. The disorder of speaking due to muscular problems is called dysarthria. Patients have to train and learn techniques to be better understandable. If this is impossible, they have to be encouraged to write the message down or have to be provided with an electronic communicator.

Swallowing problems need identifying early to minimize the risk of aspiration-related infections developing and malnutrition or dehydration. Management of dysphagia is an important clinical province of logopaedics. Their strategies for dysphagia treatment involve modification of either eating behavior, modifying the consistency of food and drinks, or postural adjustment. They also teach swallow techniques (facilitation and maneuvers).

If all other methods fail and the patient is not getting sufficient nutrition and hydration, a percutaneous gastrostomy tube (PEG), also known as a feeding tube, may be necessary. The decision to get a PEG is highly personal. Patients are understandably reluctant to undergo an invasive procedure that bypasses the normal eating process, yet some are ultimately relieved after the surgery and find they get some of their strength back after receiving adequate nutrition again.

Amyotrophic Lateral Sclerosis - Psychology

Often patients suffer from depressive disturbences. Coping with the disease or problems of social integration may be reasons. Patients have to be informed about the course of the disease in an adequate way. Sometimes it may helpful to give psychological support. Only with a constructive attitude patients can deal with the disease in the best way. Antidepressants can help to handle with the depression, as well.

The family/partner of the patient also may need psychological support. In many regions support groups for patients with Amyotrophic Lateral Sclerosis do important work. The groups provide a platform for persons with ALS and their partners to discuss any relevant or personal issues, and professionals working in this particular field are often featured speakers.

Amyotrophic Lateral Sclerosis - Inpatient Rehabilitation

The Klinik Hoher Meissner provides a qualified rehabilitation treatment program that helps patients maintain the highest possible level of functioning. Following a complete evaluation, the treatment team teaches individuals to improve movement and to develop ways to compensate for any loss of function. Led by a specialized physician the team includes nurses, physical, occupational and speech therapists, psychologists and dieticians. Together with the patient the team works out an appropriate treatment plan. The aim of our inpatient rehabilitation is a lasting improvement of functions and abilities.

The opportunity to live together with the patient in our clinic is used by the spouses quite often. The patient can concentrate on the therapies without labour, housework or other stressing factors of home.

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Klinik Hoher Meissner

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