Do you sometimes feel like something like a cup or a pen suddenly falls to the ground for no reason? Or do you feel like your legs are tripping when you walk, or your words are slurred when you speak? Although these are usually just things that happen to us, sometimes they can be the first signs of something serious happening inside our body. That's how we're going to talk about a disease related to our nervous system today. That's ALS.
Simply put, what is ALS?
ALS is an abbreviation for Amyotrophic Lateral Sclerosis . Some people also call it 'Lou Gehrig's disease', after Lou Gehrig, a famous baseball player in the 1930s. Simply put, it is a disease that affects our nervous system, especially the nerve cells called motor neurons .
Now you may be wondering what these motor neurons are. Imagine, you raise an arm, move a leg, talk, chew food... You do all of this voluntarily, right? Well, these motor neurons control the voluntary muscles that we think about and control. These nerve cells carry the message from the brain to the muscles, saying, "Do this." When ALS develops, these motor neurons gradually weaken and become inactive. Then the messages from the brain do not reach the muscles properly. As a result, the muscles gradually weaken and shrink.
The saddest thing is that this disease eventually weakens the diaphragm, the muscle that helps us breathe. Many patients die from respiratory failure . There is still no definitive cure for this disease.
What are the risk factors for developing ALS?
The exact cause of ALS has not yet been discovered, but some risk factors have been identified.
- Genetics: For a small percentage of people with ALS, about 10%, it is hereditary. This means that if someone in the family has the disease, there is a 50% chance that the gene will be passed on to their children. This is called familial ALS .
- Age: The risk of developing this disease increases with age up to the age of 75. The disease is most often diagnosed in people between the ages of 60 and 80.
- Sex: Among people under the age of 65, men are slightly more likely to develop the disease than women. However, after age 70, that difference disappears.
- Smoking: Some studies have shown that smokers are at increased risk of ALS, especially in women after menopause.
- Toxins : Researchers believe that exposure to certain chemicals, such as lead, may also be a risk factor. This is still being investigated.
- Military service: Surprisingly, some studies have shown that those who have served in the military have a slightly higher risk of developing ALS. The exact cause is not known, but it is thought to be related to factors such as exposure to toxins and severe stress.
- Stumbling while walking, legs getting tangled.
- Difficulty holding something firmly in the hand (e.g., dropping cups, pans).
- Slurred speech.
- Difficulty swallowing food or liquids.
- Muscle cramps or pain.
- Muscle twitching - also called fasciculations .
- Difficulty maintaining body posture, inability to keep the neck straight.
- EMG (Electromyography): This measures the electrical activity in the muscles. In ALS, the muscles do not receive signals from the nerves properly, so the EMG test shows a specific abnormal pattern.
- Nerve Conduction Study: This measures the speed at which electrical signals travel along nerves. This can give an idea of the extent of damage to the nerves.
- Physical therapy: Helps with large muscle activities like walking and standing.
- Occupational therapy: Helps with fine motor skills such as buttoning a shirt and eating with a spoon.
- Speech therapy: Helps clarify speech and manage swallowing difficulties.
- ALS is a disease that affects the nerve cells called motor neurons that control our voluntary muscles.
- Early symptoms can be very subtle, including weakness in the limbs, difficulty walking, and slurred speech.
- There is no specific test to diagnose the disease, and the diagnosis is confirmed by ruling out other diseases.
- Although there is still no complete cure for the disease, physical therapy, speech therapy, and various assistive devices can maintain the patient's quality of life at a good level.
- If you have these symptoms for a long time, definitely seek medical advice.
Important: If you suspect that you have ingested a toxic chemical, do not panic and call the National Poisons Information Centre at the Colombo National Hospital for proper medical advice.
What are the first symptoms of ALS?
ALS symptoms don't come on suddenly, but very slowly. At first, you may notice very little change. Maybe your hand feels numb when you hold the steering wheel of a car. Or you may have difficulty speaking before any other symptoms appear. The initial symptoms vary from person to person.
But there are some common early symptoms:
This disease can be divided into two main types based on how it begins: Limb onset (begins in the limbs) and Bulbar onset (begins with difficulty speaking and swallowing) .
| How the disease begins | Common symptoms |
|---|---|
| Limb (Spinal) Onset | For many people, the disease begins this way. Symptoms first appear in the arms or legs.
|
| Bulbar Onset (onset with speech/swallowing) | This is a little less common. Symptoms first begin in the muscles of the face, neck, and throat.
|
| This disease worsens over time. | |
| When the disease worsens | Muscle weakness, loss of muscle mass (atrophy), difficulty chewing and swallowing, inability to understand speech, and difficulty breathing. |
How is ALS diagnosed?
Diagnosing ALS is a complicated process because there is no single test that specifically diagnoses it. Doctors rule out all other conditions that could be causing your symptoms before making a diagnosis of ALS.
Your doctor, especially a neurologist, will perform these tests:
1. Complete medical examination: We will discuss your symptoms and family medical history at length, and check for muscle weakness, muscle spasms, and speech difficulties.
2. Blood and urine tests: These help rule out other conditions that may show symptoms similar to ALS, such as thyroid disease, vitamin B12 deficiency, and other infections.
3. MRI scan: An MRI does not directly show ALS, but it is essential to check for other causes, such as a brain or spinal cord tumor or a slipped disc.
4. Electrophysiological tests: These are very important in diagnosis.
Because an ALS diagnosis is a big deal, many people are tempted to get a second opinion. That's a good thing. Also, because the disease progresses over time, it's helpful to get tested again after about 6 months to see if symptoms have improved.
How to manage symptoms?
Although there is still no complete cure for ALS, there are many ways to manage symptoms and improve the patient's quality of life.
In addition, there are devices such as wheelchairs, CPAP machines to help with breathing, and specialized computer technologies (eye-recognition software) to help those who have difficulty speaking communicate.
If you or someone you know continues to experience the symptoms mentioned here, please do not waste time and see a qualified doctor . Early detection of the disease is a great help in managing it.
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