How Amyotrophic Lateral Sclerosis (ALS) Is Treated

If you or a loved one has amyotrophic lateral sclerosis (ALS), you should know that the condition involves a substantial amount of medical care.

You will work with a variety of healthcare providers who will help you get the most updated ALS treatment that is used to slow disease progression, as well as treatments to help alleviate some of the effects of the condition.

Because ALS is a serious and incurable disease, there is a great deal of research looking at potential cures. In addition to the approved therapies, you might also be able to enroll in a clinical trial, so you can receive treatments that have not yet been approved or made widely available.

This article will discuss treatment for amyotrophic lateral sclerosis, including lifestyle approaches, medication, specialist-driven procedures, and complementary therapies.

Prescriptions

Prescription medications are used to slow disease progression in people who have been diagnosed with ALS. Each of the ALS medications has a different mechanism of action, with the overall goal of preventing the degeneration of the motor neurons.

Each of these treatments has been shown to improve survival by at least several months. They are approved to be used alone, but some research trials may involve the use of multiple ALS treatments. 

The treatments approved by the Food and Drug Administration (FDA) for the treatment of ALS include:

• Rilutek (riluzole): Rilutek is a pill that's prescribed to be taken daily. Other formulations are also available. Tiglutik is a liquid formulation of riluzole, and Exservan is available as a film that dissolves on the tongue.
• Radicava (edaravone): This medication is available as an oral formulation and a formulation that is taken intravenously.
• Relyvrio (sodium phenylbutyrate/taurursodiol): This is an oral medication that can be taken by mouth or through a feeding tube. It is prescribed to be taken daily.

Experimental treatment for ALS includes approaches such as gene therapy, which you could potentially have access to by enrolling in a clinical trial.

Additionally, treatments for the prevention of deep vein thrombosis (DVT) may be prescribed for some people who have ALS. Medication may also be required for episodes of illness, such as pneumonia (lung infection) or any other type of infection. 

Over-the-Counter (OTC) Therapies

Nonprescription medications are not a major part of ALS care. But sometimes over-the-counter (OTC) therapies can be useful for managing some of the symptoms that occur due to ALS, such as pain, constipation, and heartburn. 

For some people with ALS, muscle cramping can cause pain, and OTC pain treatments, such as nonsteroidal anti-inflammatory drugs (NSAIDs) may relieve pain or discomfort. These include Advil (ibuprofen) and Aleve (naproxen).

Be sure to discuss any OTC medication use with your healthcare providers and to check whether they interact with any other treatments that you take. Even for OTC treatments, you should get directions about the dose and frequency that’s right for you.

Surgeries and Specialist-Driven Procedures  

Because ALS leads to significant disability, certain procedural interventions are often needed. These treatments can help prolong survival by maintaining breathing, nutrition, and mobility. 

Feeding Devices 

Many people who have ALS lose the ability to chew and swallow. Often, a feeding tube is placed surgically into the stomach so that nutrition can be provided directly into the tube.

Often, nutrition planning with a professional nutritionist is necessary to ensure that you receive the right number of calories and nutrients through foods or supplements. 

Ventilator Support 

Loss of respiratory muscle strength is extremely common in ALS. Mechanical support for ventilation is often necessary for survival. This involves either placement of a tube down the throat or the surgical placement of a tube into the trachea (windpipe), which is attached to a machine that may provide oxygen and control your breathing rate.

Physical Therapy 

Weakness, muscle cramps, and muscle twitches severely limit mobility in ALS. Therapy can help reduce the amount of muscle atrophy (thinning of the muscles) and spasms and may reduce pain and help with muscle control. Physical therapy can also help prevent some complications of inactivity, such as pneumonia and DVT. 

Speech therapy and swallowing therapy are also important aspects of interactive therapy for ALS. 

Mobility/Support Devices 

Many people with ALS need to use devices for support and mobility, and this need may come soon after diagnosis. These can include splints, wheelchairs, or devices to help move to and from the toilet.

Learning how to use assistive devices is crucial, and you will likely need to use devices that provide more support as your disease progresses.

Home Remedies and Lifestyle

To get the most benefits out of your ALS treatments, it’s crucial to use lifestyle approaches that can help you avoid complications. 

Lifestyle management includes strategies to maintain safe mobility, avoid falls, prevent pressure sores, and get proper nutrition without choking. Additionally, if you have a feeding device or use a ventilator to assist with breathing, these devices must be used correctly and be properly cleaned to function well without causing an infection. 

These lifestyle interventions require a degree of learning, and managing them is time-consuming. Some families learn how to take care of the lifestyle adjustment themselves, but most families need help from a professional caregiver who visits the home. ALS care can become intense, sometimes requiring a move to an assisted care facility. 

Complementary and Alternative Medicine (CAM)

Some types of treatments that are considered complementary or alternative can be beneficial for managing certain symptoms associated with ALS. However, it’s important to be aware that there are no alternative treatments that can affect disease progression.

The complementary or alternative treatments most beneficial for people who have ALS are:

• Massage: Therapeutic massage can relieve the sensations of muscle discomfort. 
• Acupuncture: Specific acupuncture points have been found to help with some of the discomfort associated with ALS, but it does not prolong survival.

Herbal remedies have not been found to be helpful for managing ALS.

Summary 

Living with ALS means that you will need lifelong medical treatment and that you will need to see many different healthcare providers who will manage various aspects of your care. Your treatment will involve day-to-day lifestyle management to lower your risk of complications—like infections. And OTC treatments can help control some symptoms.

Prescription medications indicated for ALS treatment may help slow disease progression. Interventions for managing the condition as it advances—such as feeding tubes and ventilator support—are often needed.

The overall care of ALS can also include home health providers who will work with your family to help ease the challenges of managing your overall day-to-day care.

A Word From Verywell

While ALS is not curable, some treatments may help slow disease progression and improve your quality of life. You can decide on which treatments you will have and whether you want to participate in a clinical trial. Your healthcare team, along with your loved ones, will work with you and together to ensure that you get the most benefits out of your treatments.