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AMYOTROPHIC LATERAL SCLEROSIS TREATMENTS |
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There is no cure for Amyotrophic Lateral Sclerosis, and no
treatment that can significantly alter its course. There are many
things which can be done, however, to help maintain quality of life
and to retain functional ability even in the face of progressive
weakness. As of early 1998, only one drug had been approved for treatment of Amyotrophic Lateral Sclerosis. Riluzole (Rilutek) appears to provide on average a three-month increase in life expectancy when taken regularly early in the disease, and shows a significant slowing of the loss of muscle strength. Riluzole acts by decreasing glutamate release from nerve terminals. Experimental trials of nerve growth factor have not demonstrated any benefit. No other drug or vitamin currently available has been shown to have any effect on the course of Amyotrophic Lateral Sclerosis. A physical therapist works with the patient and family to implement exercise and stretching programs to maintain strength and range of motion, and to promote general health. Swimming may be a good choice for people with Amyotrophic Lateral Sclerosis, as it provides a low-impact workout to most muscle groups. One result of chronic inactivity is contracture, or muscle shortening. Contractures limit a person's range of motion, and are often painful. Regular stretching can prevent contracture. Several drugs are available to reduce cramping, a common complaint in Amyotrophic Lateral Sclerosis. An occupational therapist can help design solutions to movement and coordination problems, and provide advice on adaptive devices and home modifications. Speech and swallowing difficulties can be minimized or delayed through training provided by a speech-language pathologist. This specialist can also provide advice on communication aids, including computer-assisted devices and simpler word boards. Nutritional advice can be provided by a nutritionist. A person with Amyotrophic Lateral Sclerosis often needs softer foods to prevent jaw exhaustion or choking. Later in the disease, nutrition may be provided by a gastrostomy tube inserted into the stomach. Mechanical ventilation may be used when breathing becomes too difficult. Modern mechanical ventilators are small and portable, allowing a person with Amyotrophic Lateral Sclerosis to maintain the maximum level of function and mobility. Ventilation may be administered through a mouth or nose piece, or through a tracheostomy tube. This tube is inserted through a small hole made in the windpipe. In addition to providing direct access to the airway, the tube also decreases aspiration. While many people with rapidly progressing Amyotrophic Lateral Sclerosis choose not to use ventilators for lengthy periods, they are increasingly used to prolong life for a short time. The progressive nature of Amyotrophic Lateral Sclerosis means that most patients will eventually require full-time nursing care. This care is often provided by the spouse or other family member. While the skills involved are not difficult to learn, the physical and emotional burden of care can be overwhelming. Caregivers need to recognize and provide for their own needs as well as those of the patient, to prevent depression, burnout, and bitterness. Throughout the disease, a support group can provide important psychological aid to the patient and caregiver as they come to terms with the losses Amyotrophic Lateral Sclerosis inflicts. Support groups are sponsored by both the Amyotrophic Lateral Sclerosis Society and the Muscular Dystrophy Association (see Resources). Alternative treatment Given the grave prognosis and absence of traditional medical treatments, it is not surprising that a large number of alternative treatments have been tried for Amyotrophic Lateral Sclerosis. Two studies published in 1988 suggested that amino-acid therapies may provide some improvement for some people with Amyotrophic Lateral Sclerosis. While individual patient reports claim benefits for megavitamin therapy, herbal medicine, and removal of dental fillings, for instance, no evidence suggests that these offer any more than a brief psychological boost, often followed by a more severe letdown when it becomes apparent the disease has continued unabated. However, once the causes of Amyotrophic Lateral Sclerosis are better understood, alternative therapies may be researched more intensively. For example, if damage by free radicals turns out to be the root of most of the symptoms, antioxidant vitamins and supplements may be used more routinely to slow the progression of Amyotrophic Lateral Sclerosis. Or, if environmental toxins are implicated, alternative therapies with the goal of detoxifying the body may be of some use. |
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