Symptomatic treatment of ALS

Patients with symptoms suggestive of a progressive neurologic disease, such as amyotrophic lateral sclerosis (ALS), usually seek an initial medical consult to obtain a diagnosis, although their primary goal is ultimately to obtain some form of treatment that will ameliorate their condition. However, physicians can easily become focused on the etiologic aspects of the disorder in the pursuit of a definitive diagnosis. Patients respond by becoming preoccupied with the clinical significance of specific clinical and laboratory findings and determining how these relate to the pathophysiology of the disease. Therefore, it is often necessary for both the physician and the patient to shift their focus of attention away from diagnostic issues and to concentrate their efforts on identifying the interventions that will best lessen disease progression and/or provide symptomatic relief.

Two types of treatment options are available for patients with ALS: those that are disease-specific and those that are patient-specific. As discussed in detail elsewhere in this issue, there is an expanding armamentarium of potentially useful pharmacologic agents for the treatment of ALS. Riluzole, a glutamate antagonist, is the only agent approved for the treatment of ALS. Others (e.g., other glutamate inhibitors, neurotrophic factors) are now undergoing clinical trials or are being used on an experimental basis. Although at present there is no cure for ALS, a drug such as riluzole has been shown to slow disease progression and improve survival outcomes. ^[1,2] Disease-specific therapies are only one aspect of an overall management program for ALS. Many symptomatic treatments designed to enhance the patient's overall quality of life by mitigating the complications of ALS and enhancing patient comfort provide an equally important dimension of patient care.

This article discusses the approaches now in use to manage some of the most common symptoms of ALS, including the following: impaired speech and other …