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.
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 |
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 |