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Medications and Treatments

The primary focus for the treatment of ALS is on slowing symptom progression, managing symptoms as they arise, maximizing function, providing comfort and promoting quality of life.

At Hennepin Healthcare, ALS patients have access to a multidisciplinary team – which consists of providers trained in many different areas to help with the complex physical, mental and social issues facing ALS patients. This integrated multidisciplinary team works together to prolong your survival concentrating on your quality of life and maximizing your function.

Based on your diagnosis, your team will help you select the right treatments, medications and therapies.

Medications

There are two FDA-approved medications for the treatment of ALS.

  • Riluzole (Rilutek) has been shown to modestly slow disease progression by reducing levels of a chemical messenger in the spinal cord called glutamate. Side effects of Riluzole may consist of dizziness, nausea, fatigue and elevated levels of liver enzymes (detected by a blood test). Riluzole is an oral medication.
  • Edaravone (Radicava) is an intravenous medication that has been shown to modestly slow disease progression in select patients through an anti-oxidant mechanism. This medication was first approved in 2017 and may have mild side effects such as bruising, headaches and dizziness.

Besides Riluzole and Edaravon, your doctor may use other medications to relieve individual symptoms such as:

  • Pain, muscle cramps, spasms
  • Depression and fatigue
  • Difficulty with sleep
  • Excessive phlegm or salivation problems
  • Muscle twitching
  • Muscle stiffness (spasticity)
  • Constipation
  • Uncontrolled outbursts of crying or laughing

Therapy

Physical therapy

Physical therapy can address your walking, mobility and equipment needs that help maintain your independence.

A physical therapist may provide you with equipment such as a brace, walker or wheelchair to make it easier for you to get around. A physical therapist can also help you understand how to modify your home to be more accessible as you become weaker.

Occupational therapy

An occupational therapist can help accomplish daily activities such as eating, dressing, grooming, writing, and bathing.

Occupational therapists have a good understanding of how to modify or recommend simple adaptive equipment (such as built up utensils, button hooks, zipper pulls handwriting aids) that can be used even if your hands are weak.

Speech-language pathology

Speech-language pathologists (SLP) are an integral part of the multidisciplinary team because as ALS affects the muscles you use to speak, communication becomes an issue as the disease progresses.

At the point at which speech changes can be readily detected, together you and your speech pathologist will choose the best strategies to help you and your communicative partners enjoy improved and less frustrating communication. Strategies may include maximizing the listening environment, modifying your speech pattern, as well as using technology to assist in clarifying your messages such as a tablet computer with text-to-speech applications or computer-based technology with synthesized speech.

The speech-language pathologist will also evaluate swallowing ability. Assessment of swallowing may take the form of a clinical exam as well as an instrumental study: A modified barium swallow (MBS) test, administered by an SLP and a radiologist, can help provide recommendations to help with swallowing.

Cognitive-linguistic screening 

This screening is included in the overall assessment to identify changes in behavior, comprehension and higher levels of reasoning and problem-solving.

Nutritional support

A dietician will work with you and your family members to make sure you're eating nutritious foods that are easier to swallow and that you are meeting your nutritional needs, even when eating becomes more difficult.

Psychological and social support

Social work in the Hennepin Healthcare ALS Center of Excellence is available to provide support and processing to individuals diagnosed with ALS, their caregivers, and family members. This includes adjustment to the diagnosis and changes in ability and lifestyle. The social worker is also there to help you navigate systems that will provide resources and community-based resources (such as meal delivery).

Your doctor may also refer you to psychologists and psychiatrists if needed.

Respiratory management

Over time, you'll have more difficulty breathing as your muscles become weaker. A respiratory therapist will test your breathing regularly and provide you with devices to assist your breathing as needed. In some cases, you may choose to breathe through a machine.

Palliative care

Palliative care is a specialized field of medicine that will help support you through symptom management and complex medical decisions, such as end-of-life matters. You will have access to board-certified palliative care physicians and advance care planning documents such as advance directives and Provider Orders for Life Sustaining Treatments (POLST) forms.

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