Treatment

Weeks 8 and 9: TReATMENT

Welcome to module 4 of PATHOL 4014A. Weeks 8 and 9 will explore treatment options for patients with ALS.

This module serves to provide an introduction to this week's course content, but please listen to the provided introductory audio, as well as reading the suggested textbook sections provided on the Brightspace page before attending lecture each week.

treatment.mp3

Treatment: Introductory Audio

Treating ALS

Current treatments for ALS aim to manage symptoms, slow the progression of the disease, and enhance quality of life. While these treatments cannot reverse the damage caused by ALS, they play a vital role in providing supportive care and improving daily living for those affected11-13.

Here is a short video narrated by Fernando G. Vieira that helps describe the difficulties with curing ALS13:

Symptom Management

ALS symptom management focuses on enhancing quality of life and addressing the challenges posed by the disease. Non-medication therapies play a crucial role in supporting patients, and these often include:

Physical Therapy11,12,14

Focused on maintaining mobility, reducing stiffness, and delaying muscle atrophy through personalized stretching and strengthening exercises.
Although it does not stop disease progression, it helps preserve independence, increase comfort, and support safer movement.

Speech Therapy11,12,14

Focuses on managing speech and difficulties with swallowing as the disease gets worse.
Therapists teach strategies to improve communication and could provide or introduce alternative communication devices.
Could include speech apps or eye-tracking apps.
Helps to maintain the ability to communicate effectively.

Occupational Therapy11,12,14

Helps to maintain independence in daily tasks like dressing, eating, and grooming by teaching adaptive techniques and providing or introducing assistive devices.
Home and/or work environment can also be modified.

Respiratory Support11,12,14

Important as the muscles involved in breathing gradually weaken.
Non-invasive ventilation (such as a mask that assists with breathing) can improve comfort, sleep quality, breathing, and help extend survival by supporting lung function.

Psychological and Emotional Support11,12

Helps both the patient and the patient’s caregiver(s) navigate the mental and emotional impact of ALS.
Counseling, therapy, and support groups provide a space to process feelings, reduce stress, and build resilience throughout the course of the disease.

Nutritional Support11,12,14

Helps manage swallowing difficulties and maintain proper energy intake as the disease progresses.
May involve modifying food textures or instructing feeding tubes to ensure patients receive adequate nutrition and avoid weight loss

These therapies are tailored to the individual needs of each patient, offering vital support as the disease progresses.

FDA-approved Medications

Edaravone (Radicava)11,12

Edaravone is a treatment for ALS that is available as an intravenous infusion or an oral liquid. It works by reducing oxidative stress, a process that can damage motor neurons, potentially helping to preserve muscle function. The medication has been shown to slow the decline in physical ability, particularly in people with early-stage ALS who still retain significant motor function.

Common side effects include bruising, headaches, and difficulty walking.

The impact on life expectancy is still being studied.

Riluzole (Rilutek, Exservan, Tiglutik)11,12

Riluzole is an oral medication used to treat ALS by decreasing the release of glutamate, a neurotransmitter that may contribute to motor neuron damage. By limiting this release, riluzole can help slow disease progression and has been shown to extend survival by approximately 2 to 3 months.

It is available in tablet, oral film, and liquid formulations, making it accessible for patients with swallowing difficulties.

Common side effects include dizziness, nausea, or other gastrointestinal issues. In rare cases, it can affect liver function, so regular blood tests are recommended to monitor liver health during treatment.

Test your knowledge

Google Form Link

What is the main goal of ALS treatments?

A. Cure the disease
B. Reverse nerve damage
C. Manage symptoms and slow progression
D. Replace motor neurons

Which of the following is NOT part of ALS symptom management?

A. Physical therapy
B. Occupational therapy
C. Radiation therapy
D. Speech therapy

What is Edaravone’s primary function in ALS treatment?

A. Reduce oxidative stress
B. Increase muscle mass
C. Boost dopamine levels
D. Block neurotransmitters

Riluzole helps ALS patients by:

A. Reducing glutamate release
B. Increasing serotonin
C. Enhancing glucose absorption
D. Promoting neurogenesis

Which of the following therapies supports breathing in ALS?

A. Speech therapy
B. Non-invasive ventilation (NIV)
C. Physical therapy
D. Psychotherapy

Feeding tubes are used in ALS to address:

A. Communication challenges
B. Swallowing difficulties
C. Respiratory issues
D. Skin infections

Psychological support in ALS is essential for:

A. Only the patient
B. Only the caregiver
C. Both patient and caregiver
D. Not recommended

Which therapy helps maintain mobility in ALS?

A. Speech therapy
B. Physical therapy
C. Vision therapy
D. Hormonal therapy

Riluzole typically extends life by:

A. 1 year
B. 6 months
C. 2-3 months
D. 5 years

What type of therapy assists with daily tasks like dressing?

A. Occupational therapy
B. Respiratory therapy
C. Cognitive therapy
D. Genetic therapy

Answer Key

C. Manage symptoms and slow progression
C. Radiation therapy
A. Reduce oxidative stress
A. Reducing glutamate release
B. Non-invasive ventilation (NIV)
B. Swallowing difficulties
C. Both patient and caregiver
B. Physical therapy
C. 2-3 months
A. Occupational therapy

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