eMedicine Specialties > Emergency Medicine > Neurology

Amyotrophic Lateral Sclerosis: Follow-up

Author: Kathleen Clem, MD, FACEP, Chair, Department of Emergency Medicine, Loma Linda University Medical Center
Coauthor(s): Joel C Morgenlander, MD, Professor, Division of Neurology, Duke University School of Medicine; Consulting Staff, Electromyography Laboratory, Muscular Dystrophy Association Clinic, Duke University Medical Center
Contributor Information and Disclosures

Updated: Sep 15, 2009

Follow-up

Further Inpatient Care

  • Physical and occupational therapy and speech pathology consultations assist the patient with amyotrophic lateral sclerosis (ALS) in maintaining strength, daily living activities, and communication skills.
  • When forced vital capacity (FVC) reaches about 50% of predicted levels, supplemental respiratory support may be needed. (The first symptom may be disturbed sleep.) Use of noninvasive positive pressure ventilation improves quality of life; further respiratory deterioration may necessitate tracheostomy and ventilator support.
  • Patients with progressive weight loss, symptomatic dysphagia, or aspiration should be considered for percutaneous gastrostomy placement. Risk of percutaneous endoscopic gastrostomy (PEG) placement increases with declining respiratory function. PEG is best placed before FVC falls to less than 50% of predicted levels.
  • Advance directives should be addressed by the patient's neurologist early in the course and should be discussed at regular intervals. Hospice referral may be appropriate to aid in care during the terminal phase of the disease.

Further Outpatient Care

  • Early in the treatment course of ALS, encourage patients to continue routine activities.
  • Patients are best cared for in a designated ALS center. Many mechanical aids can help overcome disabilities.
  • Patients' length of survival and quality of life are enhanced by night-time breathing assistance early in the course of the disease and by aggressive application of alternate feeding options to ensure good nutrition once swallowing becomes difficult.6

Inpatient & Outpatient Medications

  • Medications are patient specific.

Complications

  • Pneumonia
  • Urosepsis
  • Constipation
  • Depression
  • Muscle cramps
  • Immobility-related problems

Prognosis

  • ALS is a fatal disease. Younger patients may have a slower rate of progression. Patients with bulbar onset, particularly the lower motor neuron type, have a poorer prognosis.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Refer patients to a neurologist. In a patient with an established diagnosis of ALS, follow advance directives.
 


More on Amyotrophic Lateral Sclerosis

Overview: Amyotrophic Lateral Sclerosis
Differential Diagnoses & Workup: Amyotrophic Lateral Sclerosis
Treatment & Medication: Amyotrophic Lateral Sclerosis
Follow-up: Amyotrophic Lateral Sclerosis
Multimedia: Amyotrophic Lateral Sclerosis
References
Further Reading
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References

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Keywords

ALS, Lou Gehrig disease, Lou Gehrig's disease, amyotrophic lateral sclerosis, Charcot disease, Charcot's disease, motor neuron disease

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Contributor Information and Disclosures

Author

Kathleen Clem, MD, FACEP, Chair, Department of Emergency Medicine, Loma Linda University Medical Center
Kathleen Clem, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Joel C Morgenlander, MD, Professor, Division of Neurology, Duke University School of Medicine; Consulting Staff, Electromyography Laboratory, Muscular Dystrophy Association Clinic, Duke University Medical Center
Joel C Morgenlander, MD is a member of the following medical societies: American Academy of Neurology, American Stroke Association, and North Carolina Neurological Society
Disclosure: Nothing to disclose.

Medical Editor

Roy Alson, MD, PhD, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Wake Forest University School of Medicine; Medical Director, Forsyth County EMS; Deputy Medical Advisor, North Carolina Office of EMS; Associate Medical Director, North Carolina Baptist AirCare
Roy Alson, MD, PhD, FACEP, FAAEM is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, North Carolina Medical Society, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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