Amyotrophic lateral sclerosis (ALS) is also called Lou Gehrig’s disease. It’s a neuromuscular disorder that causes muscle weakness. ALS symptoms include difficulty talking, swallowing and moving. Eventually, breathing becomes difficult. ALS treatment includes therapies and medications to manage the symptoms and slow the progress of the disease.
Amyotrophic lateral sclerosis, or ALS, is a type of motor neuron disease. It’s also known as Lou Gehrig’s disease. ALS affects motor neurons — nerves that control your voluntary muscles. Voluntary muscles are the ones you use for actions like chewing, talking and moving your arms and legs. ALS is progressive, meaning that the symptoms get worse over time. If you have ALS, your muscles begin to atrophy or waste away. Your muscles get weaker over time, making it difficult to walk, talk, swallow and eventually breathe. Most people with ALS die of respiratory failure when their lungs can’t get enough oxygen to the blood.
Although there’s no cure for ALS, the treatments are constantly improving. The right combination of treatments can slow the progression of the disease and help people with ALS live a good quality of life.
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Lou Gehrig was a famous baseball player in the 1920s and 1930s. ALS ended his career. He died of the disease a few years after getting diagnosed.
As your motor neurons (nerve cells) continue to decline, they can’t send signals to your muscles. The two types of motor neurons are:
Most often, ALS affects both upper and lower motor neurons.
You may have different symptoms if mostly upper or mostly lower motor neurons are affected. Upper motor neuron disorders cause muscle stiffening. Lower motor neuron diseases cause a loss of muscle tone. Both upper and lower motor neuron problems cause weakness.
ALS can make breathing difficult or ineffective. That’s because it affects the muscles that move your chest and lungs. These muscles include the diaphragm, which separates your chest from your belly. Other breathing muscles affected include those between your ribs.
Pulmonary (breathing) problems you can get with ALS include:
ALS doesn’t affect your:
It also usually doesn’t affect your sexual, bowel or bladder functions. Memory problems develop in about half of patients diagnosed with ALS and are often mild. About 10% of patients develop dementia.
Healthcare providers use a system to classify types of motor neuron diseases:
Healthcare providers also divide ALS into two categories, based on where the disease comes from:
Worldwide, around one to two people per 100,000 get diagnosed with ALS every year.
Risk factors for ALS include:
Military veterans may also be at higher risk. Researchers are not sure why this is. It may be because they got exposed to lead, pesticides and other toxins during their service.
The Centers for Disease Control and Prevention (CDC) estimates that around 12,000 to 15,000 people in the United States have ALS. Every year, about 5,000 people receive an ALS diagnosis.
Researchers do not know what causes ALS. They believe it’s a combination of factors:
At first, you may notice muscle weakness or stiffness:
No matter where the symptoms begin, they soon spread to other parts of your body. As ALS progresses, symptoms include:
When ALS gets more severe, symptoms can include:
Fasciculations are muscle twitches, a common ALS symptom. While they’re not painful, they can be bothersome and disrupt your sleep. Fasciculations can also be seen in other conditions and don't always mean that you have ALS.
Your healthcare provider will do a physical exam and ask you about your medical history. You’ll also need several tests to confirm the diagnosis:
Other tests can’t diagnose ALS but can help rule out different diseases that may cause similar symptoms:
Most healthcare providers recommend a second opinion after an initial ALS diagnosis. Several conditions have similar symptoms to ALS. And many of those are treatable. It’s important to get an accurate diagnosis, so you get the treatment you need.
People with ALS get the best care from a team of specialists from many fields of medicine. This team works together to help you manage symptoms, avoid complications and live as best you can with ALS. This team may include:
There is no cure for ALS. But treatment can slow the progression of the disease. The right treatment plan can help you stay comfortable and independent for as long as possible.
The U.S. Food and Drug Administration has approved two drugs to treat ALS:
Other medications can help manage ALS symptoms. Drugs can help with muscle cramps and stiffness and extra saliva. There are also drugs to help with pain, depression, sleep problems and constipation.
The goal of physical therapy for ALS is to help you remain independent and safe. Gentle aerobic exercise, such as walking or swimming, can strengthen muscles and improve heart health. These exercises can also help you feel more energetic and less depressed.
Physical therapists can create an exercise plan that helps you feel your best without overworking your muscles.
Occupational therapists can teach you techniques and strategies for moving through your day. They can also help figure out what devices will help you most. For example, wheelchairs, braces or walkers can help you move without feeling exhausted.
Speech therapy can help you learn new ways to speak loudly and clearly. As ALS progresses, you may find it difficult to talk. Speech therapists can help you maintain your communication skills. They can also teach you ways to communicate nonverbally. Even if you still have verbal abilities, nonverbal communication can help you conserve energy.
A speech-language pathologist can also:
Some people with ALS choose to do voice banking. While you can still speak, you record your voice in a device called a speech synthesizer. If you can’t speak later on, you can use the speech synthesizer to communicate.
People with ALS lose weight quickly. Getting the right nutrition helps you keep your strength. Nutritionists create a meal plan that:
At some point, you may need a feeding tube to get the nutrition you need. A feeding tube also reduces the risk of choking and pneumonia. These complications come from accidentally inhaling liquid or food in your lungs.
As the disease progresses, you may find it hard to breathe. You may benefit from noninvasive ventilation (NIV). You get NIV through a mask that you wear over your nose and mouth.
Eventually, you may need mechanical ventilation, which means getting put on a respirator. This machine helps you breathe. It inflates and deflates your lungs. You’ll discuss this option with your care team and loved ones when it’s time to decide.
There’s no proven way to prevent ALS. If you have ALS, you can take part in clinical trials and the National ALS Registry. Doing so can help further understanding of the disease. As researchers gain more knowledge about ALS, they can learn more about causes and risk factors. This information may lead to prevention methods and better treatments.
A person’s prognosis depends on how quickly the symptoms progress. Typically, people with ALS live for about three to five years after diagnosis. But others can live for 10 years or even more.
People with ALS can use these strategies to communicate effectively:
Choose an environment that is:
When you’re talking:
Consider using devices:
If people are having trouble understanding you, try to:
Nonverbal communication is also called augmentative and alternative communication or AAC. It’s a way of communicating without spoken words. People with ALS can use these techniques to communicate:
Nonverbal communication has some benefits. It can help you communicate better because it:
Your care team can help you find the right assistive device or devices. Options include:
If your friend or loved one has difficulty speaking, you can:
Staying active can help with muscle strength and overall well-being. There are several approaches you can take:
Avoid strengthening exercises, such as exercising with weights. They won’t strengthen weak muscles, and they could even make your muscles weaker.
Devices that can make it easier to move and walk include:
Make sure you’re up to date on your vaccines, including flu vaccine and Pneumovax® (pneumonia vaccine). Your healthcare provider may recommend pulmonary therapy to help you breathe easier. Your therapy team will monitor your respiratory muscles to diagnose early signs of breathing trouble. The team can also provide breathing assistive devices, such as:
Other ways to improve your breathing include:
If you received an ALS diagnosis, ask your doctor:
A note from Cleveland Clinic
Amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s disease, causes muscle weakness that worsens over time. ALS symptoms include difficulty with muscle control, such as during writing or chewing. Eventually, people with ALS lose the ability to walk, swallow and even breathe. But ALS treatments such as medication and therapy can help people with ALS live as long and independently as possible. Talk to a healthcare provider if you notice unusual muscle problems. Maybe you’ve started tripping more often or have trouble buttoning your shirts. A provider can help you get the diagnosis and treatment you need to feel your best.
Last reviewed by a Cleveland Clinic medical professional on 06/15/2021.
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