Amyotrophic Lateral Sclerosis (ALS), or Lou Gehrig’s disease, is a cluster of progressive conditions that affect the nerve cells in the spinal cord and the brain responsible for muscle movement. People with the condition gradually tend to lose their ability to move their muscles. Often, experts refer to it as a single disorder, but it is an umbrella term for a cluster of diseases. It is the most prevalent motor neuron disease.

This article lists the causes, symptoms, tests, and treatment options for amyotrophic lateral sclerosis.

Causes
ALS impacts the motor neurons, or the nerve cells responsible for voluntary muscle movements like talking and walking. Broadly, there are two groups of motor neurons. The first goes from the brain to the spinal cord and finally to the muscles across the body. These are called the upper motor neurons. The second group travels from the spinal cord to the muscles across the body. They are the lower motor neurons. When people have ALS, both of these groups of neurons deteriorate and eventually die. Naturally, the damaged motor neurons fail to send messages to the muscles.

Consequently, they stop functioning. In 10% of people, genes are responsible for ALS. Sadly, in the other 90%, the reason is unknown. However, researchers are studying the possible causes of ALS, and most studies point to a complex interaction between the environment and genes.

Risk factors
Some risk factors linked to ALS are as follows:

• Genes
  It is hereditary ALS. There is a 50 percent chance that those with ALS transfer the gene to their children.
• Age
  Risk aggravates with age and is prevalent in people between the ages of 60 and 80.
• Sex
  Before 65 years, ALS is more prevalent among men than women. However, the difference disappears after 70.
• Environment
  Some environmental factors, like exposure to lead and other substances at the workplace, can result in ALS development. Further, people who served in the military are more susceptible to developing ALS.

Symptoms
In people with ALS, the first symptom is weakness in the limb that aggravates over the next few days and worsens in the following weeks. Then, a few weeks to months later, the weakness is noted in another limb. Some people may also experience trouble swallowing and slurred speech as the first symptoms. As the condition progresses, people start experiencing more signs. Some commonly noted symptoms include the following:

• Dropping things
• Cramping and twitching of muscles, especially in the feet and hands
• Falling and tripping
• Experiencing persistent fatigue
• Losing motor control in the arms and hands
• Experiencing limb impairment
• Noticing thick or slurred speech
• Crying and laughing uncontrollably
• Experiencing trouble projecting one’s voice

With time, other symptoms may follow like the following:

• Paralysis
• Trouble swallowing and breathing

Diagnosis and tests
A patient’s healthcare provider will conduct a physical examination and inquire about their medical history. They will also order some tests for confirmation. These will include the following:

• Urine and blood tests
• MRI to assess the spine and brain for damaged areas
• Nerve conduction study to examine the nerves’ ability to send a signal
• Electromyography (EMG) to measure the electrical activity of the muscles and nerves
• Neurological examination to study the reflexes and other responses

While other tests may not help with the diagnosis, they may be instrumental in ruling out conditions with similar signs. These include the following:

• Nerve or muscle biopsy
• Spinal fluid test

Treatment
ALS can impact several areas of functioning as one loses control over voluntary movements. Support and treatments are available to manage the symptoms. So, patients will have to work with a team of professionals, including a neurologist, gastroenterologist, nutritionist, physiatrist, occupational therapist, pastoral care expert, psychologist, social worker, speech therapist, respiratory therapist, and a doctor offering palliative care, to help manage and treat the condition better. Further, family members must also be supportive because, as ALS progresses, people may need assistance when making medical decisions. Working with a local ALS body can help people with ALS and their families access support and resources.

Here are a few management options:

• Assistive devices
  These include wheelchairs, mattresses, and braces to reduce pain by supporting the body. Some may also require a feeding tube or nutritional support. Further, communication tools to express needs and thoughts may be suggested as speech becomes more challenging. Some prevalent options include electronic assistive communication devices and communication boards.
• Alternative treatment
  A medical expert may also advise physical therapy, exercise, and heat treatments to manage ALS symptoms. However, these must be performed as recommended by the healthcare team. Alternative and complementary therapy, massage, and meditation may also help with comfort and relaxation.