Therapy for ALS should be interdisciplinary. The main focus is on occupational therapy, physiotherapy, speech therapy, psychotherapeutic support, and palliative medical measures.
General measures
- Preservation of the patient’s autonomy, which means, among other things, early education and preparation of an advance directive.
- Nutritional medical measures (see below) to counteract weight loss and thus prolong the survival of the patient.
- Review of permanent medication due topossible effect on the existing disease.
Conventional non-surgical therapy methods
- Speech therapy in the early stages for prophylaxis of pneumonia (lung infection), but also for speech therapy, because speech is disturbed by impairment of the tongue, mouth, and palate muscles and by speech-dependent dyspnea (shortness of breath). Speech therapy is also recommended for dysphagia (swallowing disorder) (to learn swallowing techniques).
- Non-invasive home ventilation (“non-invasive ventilation”, NIV) – to improve life expectancy and quality of life.
Medical aids
- In the course, peroneal splint (mechanically prevents the drop of the toe, thus facilitating walking) and wheelchair become necessary.
- If the sufferer’s speech is severely impaired, communication aids such as a speech computer or letter board are prescribed.
- In the case of progressive (progressive) respiratory insufficiency, it must be weighed whether the sick person should be (permanent) ventilated (home ventilation). A distinction is made between non-invasive (machine-assisted ventilation via a breathing mask) and invasive ventilation (machine ventilation via a tracheostoma (after surgical tracheotomy)).
Regular check-ups
- Regular medical checkups
Nutritional medicine
- A multicenter study of 302 patients with amyotrophic lateral sclerosis (ALS) demonstrated that
- A diet rich in vegetables, fruits, nuts, seeds, and grains, as well as poultry, fish, and also eggs, contributed to better body function-as measured by the ALS Functional Rating Scale (ALSFRS-R).
- That a higher intake of micronutrients (vital substances; antioxidants, carotenoids) was positively associated with the ALSFRS-R.
- Milk, sausage, beef and pork were negatively associated with ALSFRS-R.
- Observance of the following specific dietary recommendations during the disease:
- In dysphagia (dysphagia), a switch to pureed foods and thickened liquids is recommended.
- High-calorie high-fat supplements to meet energy needs (see below):Patients with ALS and a particularly rapid progression have a survival gain from a high-calorie high-fat diet.
- Plant of a percutaneous endoscopic gastrectomy (PEG) (endoscopic artificial access from the outside through the abdominal wall into the stomach) in the final phase of the disease (taking into account the respiratory situation!).
- See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable food supplement: fully balanced diet for diet management of patients with underweight and malnutrition – energy concentrate as a drinkable food as a snack.
- Detailed information on nutritional medicine is available from us.
Physical therapy (including physiotherapy)
- Physiotherapy treatment in the initial stage.
- For the prevention of cramps: physiotherapy exercises and massages.
- Acute therapy for cramps: passive stretching of the muscle.
- Occupational therapy – Both physical and occupational therapy are used to promote residual muscle function and counteract muscle immobility.
- Respiratory exercises and tapping massages are designed to promote respiratory muscle function and limit bronchial mucus production.
Psychotherapy
- One quarter of those with the disease develop depression or anxiety disorders during the course of the disease, which should be treated psychotherapeutically. Patients experience the progression of the disease while fully conscious.
- Detailed information on psychosomatics (including stress management) is available from us.
