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Amyotrophic Lateral Sclerosis
There is no cure for amyotrophic lateral sclerosis. The Food and Drug Administration (FDA), however, has approved the first drug treatment for ALS. The medication, riluzole (Rilutek), is thought to reduce damage to motor neurons. Riluzole does this by decreasing the release of a substance called glutamate. Clinical trials showed that riluzole prolonged survival by several months, mostly in those patients having trouble swallowing. Riluzole also seems to extend the time before a patient needs to use a ventilator. The drug does not reverse damage that has already been done to motor neurons. Patients who take the riluzole need to be monitored for liver problems and other potential side effects.
There are other treatments for amyotrophic lateral sclerosis to relieve symptoms and improve the lives of ALS patients. Healthcare providers can design an individualized plan of medical and physical therapy and provide specialized equipment. The general goal is to keep ALS patients as mobile and as comfortable as possible.
Doctors can prescribe medications to help reduce fatigue and muscle cramps, control the spasticity often associated with ALS, and reduce excess saliva production which can complicate swallowing. Medications are also are available to help patients with depression, pain, sleep problems, and irregular bowel movements (constipation).
Visits to physical therapists and the use of special equipment can enhance quality of life throughout the course of the disease. Light aerobic exercise such as swimming, walking, and stationary biking can help to strengthen unaffected muscles. It can also improve heart health and help fight depression. Range of motion (ROM)and stretching exercises can help prevent painful spasticity and shortening of muscles.
Patients who are having speech difficulty may benefit from a speech therapist. As the disease progresses, speech professionals can help patients in developing ways for responding to "yes" or "no" questions by nonverbal means such as eye blinking. They can also recommend devices such as speech synthesizers. These can help ALS patients communicate when they are no longer able to speak.
Patients and caregivers can learn nutritionists about how to plan and prepare numerous small meals throughout the day. These help to provide enough calories, fiber, and hydration. They also teach how to avoid foods that can be difficult to chew and swallow. Patients may need suction devices that remove excess saliva and can help to prevent choking. When ALS patients can no longer get enough nourishment from eating, physicians may insert a painless gastric feeding tube. The use of a feeding tubes helps to lower the risk of choking and pneumonia by minimizing the chance that food or other liquids could be inhaled into the lungs.
Sometimes the muscles used for breathing become too weak and the use of ventilatory assistance at night may be used to aid breathing during sleep. When respiratory muscles are no longer able to allow the patient to breathe effectively, a ventilator may need to be used continuously.
Social service workers and home healthcare and hospice personnel are available to assist patients, families, and caregivers. There are many medical, emotional, and financial challenges of associated with ALS, particularly during the final stages of the disease. These people can provide support such as assistance in obtaining legal assistance and finding support groups for caregivers and patients. Nurses are often available to teach caregivers about tasks such as maintaining respirators, administering tube feedings, and moving patients to avoid painful skin ulcers and bedsores. Hospice workers can assist patients and caregivers in coping with end-of-life issues.
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