Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

How Do I Approach Lou Gehrig's Disease?

Tuesday, 20 July 2010 01:23 PM

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.

© HealthDay

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