25 Signs and Symptoms of Amyotrophic lateral sclerosis (ALS)

Amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease, is a neurodegenerative disorder that occurs without a known cause for 90% of people, but 10% are genetically predisposed to get affected. The usual onset is the fifties and above. ALS affects the voluntary muscles of the body.

ALS does not affect eye movements, bowel control, bladder control, and autonomic function (preservation of sight, smell, taste, touch, and hearing).

What are the symptoms of ALS?

The common symptoms of Amyotrophic lateral sclerosis (ALS) include:

  1. Muscle twitching (fasciculation) in the legs, arms, tongues, and shoulder.
  2. Stiffness of muscle (spasticity)
  3. Worsening muscle weakness of arms and legs
  4. Difficulty walking (tripping and falling)
  5. Clumsiness
  6. Difficulty swallowing (dysphagia)
  7. Difficulty chewing
  8. Difficulty speaking (slurred speech, dysarthria)
  9. Shortness of breath (dyspnea)
  10. Difficulty carrying out daily tasks without support
  11. Choking
  12. Rapid weight loss
  13. Anxiety
  14. Depression
  15. Problems with coordination
  16. Hyperreflexia (overactive reflexes)
  17. Fainting /feeling faint
  18. Fatigue 
  19. Memory deterioration in the late stage of ALS
  20. Sudden exaggerated changes in mood and emotions such as an uncontrollable cry or questionable laughter with no specific reason
  21. Back pain
  22. Neck pain
  23. Shoulder pain
  24. Pressure ulcers
  25. Accumulation of saliva in the mouth

How does a person get ALS?

The cause of amyotrophic lateral sclerosis (ALS) is not known, although scientific studies suggest that both genetics and motor neurons that gradually deteriorate, can increase the cause of developing ALS. 

What are risk factors for ALS?

ALS risk factors increase with:

  • Age: occurs mostly between age 55 – 75years old.
  • Being a man (It is more common in men)
  • Race: more common in Caucasians.
  • Military veterans
  • Genetic predisposition
  • Smoking
  • Traumatic brain injury

Complications of Amyotrophic lateral sclerosis (ALS)

Amyotrophic lateral sclerosis impacts physical function gradually and gets worse over time. It could lead to death from respiratory failure. 

Diagnosis of amyotrophic lateral sclerosis 

There are no specific diagnostic methods used for ALS but certain ways to check muscle affection and to rule out other potential causes of symptoms:

  • Magnetic resonance imaging (MRI)
  • Electromyography (EMG): measures the electric activities of muscles
  • Muscle biopsy
  • Lumbar puncture
  • Blood analysis
  • Urine analysis

ALS diagnostic criteria

There are two criteria used for diagnosis, such as:

El Escorial criteria: Use the presence of the four spinal cord regions involved to make a diagnosis. The four regions are bulbar, cervical, thoracic, and lumbar. (Upper motor neurons symptoms(UMN) and lower motor neurons symptoms (LMN) are used as evaluation tool)

The areas affected are categorized into:

  1. Definite ALS.
  2. Probable ALS
  3. Possible ALS
  4. Suspected ALS (is not included in the revised version of EL Escorial diagnostic criteria and its place: Laboratory supported probable ALS is used instead)
  5. Generalized ALS (all regions affected)

Awaji criteria: Has just three categories

  1. Definite ALS.
  2. Probable ALS.
  3. Possible ALS.

Note: El Escorial criteria have 98% specificity for ALS and 62.2% sensitivity, while Awaji criteria have 81.1% sensitivity and 98% specificity.

Can ALS be cured?

There is no cure for ALS. Management is symptomatic, and it is aimed at reducing the rate of deterioration of motor neurons.

  • Riluzole (Rilutek): it is taken orally and believed to reduce damage to motor neurons. Riluzole increases life expectancy by 3 – 6 months
  • Edaravone (Radicava): reduce the fast decline of motor neurons
  • Mechanical ventilator for breathing in respiratory distress cases
  • To manage other symptoms: Pregabalin, Gabapentin, Amitriptyline, NSAIDs, Acetaminophen, Opioids, Atropine, and Scopolamine.
  • Physical therapy
  • Speech therapy
  • Occupational therapy
  • Nutritional support/feeding tubes installations to prevent choking and aspiration pneumonia
  • Cannabidiol (CBD) oil to relaxes the muscles and ease the pain: CBD oil is produced from the leaves, flowers, and stalks of the hemp plant because those are the only places cannabidiol is found. It is not found in the seed, which is used to make hemp seed oil.
  • Shea butter is known to soothe muscle soreness and reduce pain and could be helpful.

Finally, this is an informative piece about amyotrophic lateral sclerosis (ALS). If you experience any ALS symptoms, make sure to consult a doctor for a proper check-up.