Symptom Directed Therapy

While there is no cure for ALS at present, there is treatment. First, Riluzole slows disease progression and improves outcome. However, the mainstay of clinical management of ALS is focused primarily on symptom relief. Treatment of symptoms increases the quality of life for people living with ALS by reducing complications and increasing comfort. Furthermore, aggressive respiratory and nutritional intervention can improve both the morbidity and mortality from ALS.

Common Symptoms

We have evaluated over four hundred and sixty seven ALS patients at six ALS centers, including the MDA/ALS Center of Hope at Drexel, to determine what symptoms are most commonly experienced, how bothersome they are, and what medicines seem to help the most. The table below presents the percentage of patients who reported a symptom and were also bothered by it enough to want to take a medicine.

Frequency of Symptoms in ALS Patients (percentage)

Fasciculation 76.9
Muscle Cramps 75.2
Muscle Stiffness 69.7
Fatigue 60.6
Depression 57.6
Sleep Disturbances 50.9
Saliva and Drooling 47.8
Constipation 47.4
Anxiety 46.4
Thick Phlegm 45.3
Labile Affect 43.6
Dry Mouth 42.9
Urinary Urgency 35.2
Laryngospasm 17.9

Medicines to treat Symptoms

There are many medicines available to treat the symptoms. However, each person is different and the choice of medicine to be used is best determined by the treating physician.

Medicines for symptoms

Symptom Medicines
Cramps quinine, baclofen, zanaflex, klonapin (clonazepam)
Anxiety xanax, buspar
Constipation dulcolax, milk of magnesium, colace, miralax, lactulose, fiber, prune juice, adequate hydration
Depression Effexor, prozac; elavil, zoloft, celexa, luvox
Dry Mouth drinking extra fluids
Twitching or Fasciculations baclofen, neurontin
Fatigue rest , NIPPV (noninvasive ventilator or bipap)
Emotional Lability (laughing or crying too easily) neurodex, zoloft, elavil
Laryngospasm baclofen, valium
Phlegm suction machine, extra fluids, robitussin and mucomist
Sleep disturbance elavil and NIPPV; sleep aides: restoril, ambien
Stiffness (Spasticity) zanaflex, baclofen, valium (diazepam), marinol
Urgency Detrol, oxybutinin

 

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