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AMYOTROPHIC LATERAL SCLEROSIS (ALS Or Lou Gehrig’S Disease)

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AMYOTROPHIC LATERAL SCLEROSIS (ALS Or Lou Gehrig’S Disease) Facts About AMYOTROPHIC LATERAL SCLEROSIS (ALS or Lou Gehrig’s Disease) Muscular Dystrophy Association • mda.org • (800) 572-1717 facebook.com/MDAnational • @MDAnews MDA and ALS completion of a 2013 study analyzing all costs, including loss of income, asso- ciated with ALS; MDA’s 2013 urging of Congress to retain the Orphan Disease MDA is the world leader in fighting ALS (amyotrophic Tax Credit, which encourages drug development for rare disorders; and MDA’s lateral sclerosis). If you’ve recently received an ALS 2014 support for the FDA Safety Over Sequestration Act, which would allow diagnosis, this booklet will help you understand the the FDA to access more of its resources to review candidate therapies. To join disorder, while guiding you to the many services MDA in the fight against ALS, become an MDA advocate at mda.org/advocacy. provides. What is ALS (amyotrophic lateral sclerosis)? MDA’s involvement with ALS began in the early 1950s, when Eleanor Gehrig, widow of Yankees first baseman ALS is primarily a disease of the parts of the nervous system that control Lou Gehrig, was searching for a way to fight the disease voluntary muscle movement. that had taken her husband’s life. Mrs. Gehrig served more The word “amyotrophic” comes from Greek roots that mean “without nour- than a decade as MDA National Campaign Chairman. ishment to muscles” and refers to the loss of signals nerve cells normally send to muscle cells. “Lateral” means “to the side” and refers to the location Lou Gehrig MDA’s nationwide network of nearly 200 specialized neuromuscular disease clinics — including more than 40 of the damage in the spinal cord. “Sclerosis” means “hardened” and refers designated ALS centers — is the largest in the United to the hardened nature of the spinal cord in advanced ALS. States. Nearly 13,500 individuals affected by ALS receive In the United States, ALS also is called Lou Gehrig’s disease, named for the MDA services. They all have access to our specialized clinics, Yankees baseball player who died of it in 1941. In Britain and elsewhere in staffed by top health professionals skilled in the diagnosis and the world, ALS is often called motor neuron disease in reference to the cells medical management of ALS. (motor neurons) that degenerate in this disorder. In addition, MDA’s Neuromuscular MDA's network of nearly 200 What happens to someone with ALS? clinics includes more than 40 Disease Registry is helping to optimize designated ALS centers. clinical outcomes and evaluate best In ALS, nerve cells that control muscle cells gradually die. In most cases, practices in ALS care. It complements the cause is unknown. As these motor neurons die, the muscles they control the National ALS Registry, overseen by become weak and then nonfunctional. Eventually, the person with ALS may the federal Agency for Toxic Substances become paralyzed. & Disease Registry (ATSDR), which focuses on the causes of ALS. Without assistive technologies such as mechanical ventilation and feeding tubes, the average life expectancy is three to five years after an ALS diagnosis. In 2013, MDA committed more than $7.8 million to services to help relieve About 4 to 10 percent of those with the disease live more than 10 years, and the day-to-day challenges faced by some survive for decades, such as British physicist Stephen Hawking, who ALS-affected families. Since its incep- has had ALS since the 1960s and is still able to practice his profession. tion, MDA has dedicated almost $325 million to ALS research and health Modern technology has allowed people with ALS to compensate to some care services. degree for almost every loss of function, making it possible even for those with almost no muscle function to continue to breathe, communicate, eat, MDA also oversees an ALS Clinical Research Network, housed at five of travel and use a computer. the largest ALS research centers in the country. It’s important to note that the involuntary muscles, such as those of the MDA and ALS advocacy heart, gastrointestinal tract, bowel and bladder, and those that regulate sex- ual functions are not directly affected in ALS. (However, prolonged inability Through MDA’s advocacy efforts and community events, we influence public to move and other effects of ALS can have some indirect impact.) Hearing, policy and therapy development. Some examples include MDA’s recom- vision and touch generally remain normal. mendations to the FDA following a groundbreaking ALS hearing in 2013; the 2 3 ALS-associated pain can occur as a result of tightness (spasticity) of muscles, in the brainstem. They’re sometimes called bulbar motor neurons, because decreased range of motion of the joints, and abnormal stresses on the muscles, the part of the brainstem that houses them has a bulblike shape. The term bones and skin that occur as a result of immobility. Pain and its management bulbar involvement means that the muscles of the face, mouth and throat should always be discussed with your health care professionals. are affected by the disease. Mild cognitive impairment is not uncommon, but severe cognitive impairment, The upper motor neurons have more complex functions. It’s harder to known as “dementia,” occurs in only about 3 to 5 percent of cases. Some with study them, and not as much is understood about them, although new ALS may experience involuntary laughing or crying spells that are unrelated techniques are changing that. to their emotional state. Called involuntary emotional expression disorder, or “pseudobulbar affect,” this symptom can be treated with medication. (For more These cells seem to exert complex control over the lower motor neurons. on these cognitive and emotional symptoms, see “Emotions and intellect” on This control allows movements to be smooth, directed and varied in page 13.) intensity. (For instance, they’re part of an elaborate system that allows a person to aim a hand at a glass of water, estimate its weight, pick it up, What happens to the nervous system in ALS? and use the right amount of force to lift it to his or her mouth, all while thinking about something else.) When upper motor neurons are lost Muscle-controlling nerve cells, or motor neurons, are divided into two types: and lower motor neurons remain, movements are still possible but upper and lower. The upper motor neurons are located on the surface of can become tight (spastic) and less precise. the brain and exert control over the lower motor neurons, which are in the brainstem and the spinal cord. In ALS, a combination of these effects is usually seen because UPPER MOTOR NEURONS both upper and lower motor neurons are dying. People with ALS The lower motor neurons are can have weak and atrophied muscles with tightness (spasticity). BRAINSTEM directly attached to muscles (BULBAR) Muscle twitches (called “fasciculations”) and cramps are common; through “wires” called axons. LOWER they occur because degenerating nerves become irritable. MOTOR Bundles of these axons leave NEURONS the spinal cord and extend out tongue Who gets ALS? to the muscles. It’s these bun- axon bundles dles that doctors are referring (nerves) ALS usually strikes in late arm middle age (the average age of to when they talk about the muscle rib muscles “nerves.” involved in onset in the United States and breathing Europe is between 56 and The function of lower motor 63) or later, although ALS also SPINAL neurons is straightforward. LOWER affects younger adults and MOTOR They send “go” signals to NEURONS even children, as well as very muscles. When these cells elderly people. Some genetic gradually die in ALS, muscles forms of ALS have their onset atrophy (shrink) and become in youth. progressively weaker and eventually unable to contract, Men are somewhat more resulting in paralysis. likely to develop ALS than are women. Studies suggest an The lower motor neurons that overall ratio of about 1.5 men control most of the muscles to every woman who devel- in the body are in the spinal ops the disorder in Western leg muscle cord. Those that control the countries. In younger-onset ALS usually strikes in late muscles of speaking, swallow- Upper motor neurons on the surface of the brain control lower patients, there seems to be a middle age but can occur in ing and facial expression are motor neurons in the brainstem and spinal cord. greater male predominance. young and elderly people. 4 5 Genetic factors are involved in the cause of ALS, and surrounding the spinal the disease can run in families (see “Does It Run in cord (spinal tap or lumbar the Family?” on page 18). ALS is “familial” (that is, puncture), which is per- there is more than one case in a family) about 5 to 10 formed by putting a needle percent of the time. The other 90 to 95 percent of the into the back between two time, it is “sporadic” (that is, there is no family history of lower vertebrae. the disease). Blood tests to exclude For years, experts have tried to find factors common to disorders that mimic ALS people who develop ALS, such as environmental toxins, also are conducted. In some occupational hazards, places of work or residence, and instances, a muscle biopsy, so forth. So far, the evidence for such risk factors and which involves taking a small MDA clinics and ALS centers are staffed by professionals who are triggers has been frustratingly unclear, although the finding sample of muscle under local highly skilled diagnosticians. of an association between developing ALS and having anesthesia, is performed. served in the Gulf War in the early 1990s has indicated one of the strongest of these proposed risk factors.
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