Question: My younger brother was diagnosed with Lou Gehrig's disease several weeks ago and is now in a nursing home. I don't want to see him there, but he is having trouble pulling his pants up and down when he has to go to the bathroom. He also falls a lot. Is there anything that can help him regain some of his muscles so he can at least stay at home?

Dr. Hibberd's Answer:

ALS (amyotrophic lateral sclerosis or Lou Gehrig disease) is a progressive degenerative motor neuron disease that progresses slowly with gradual loss of motor functions. Sensory systems, such as cognition and consciousness, are usually spared. Sadly, spasticity, weakness, and clumsiness evolve to include eventual slurred speech, difficulty swallowing, and choking with liquids. Late stages will often demonstrate uncontrollable excesses of crying or laughter.

This is a progressive neurological disorder for which we have no effective cure or any very effective treatments. Riluzole is the only FDA approved drug that seems to delay the onset of respiratory demise. A risk for liver toxicity is the trade-off. Lithium has also shown promise in some treatment regimens.

We try to control symptoms. Baclofen may improve spasticity, Benadryl may improve involuntary movements, and cramps may be improved by anticonvulsants. Saliva production can be controlled by anticholinergic medications, and mood changes can be controlled by antidepressants.

Aggressive physical and occupational therapy can help maintain mobility and comfort for activities of daily living. As respiratory weakness evolves, pulmonary specialists to supply non-invasive support such as oxygen are essential.

There is no known cure. Death often occurs within three years to 50% of victims, usually due to respiratory muscle failure. Survival over thirty years is rare, 10% will live ten years and 20% will live for five years.