ALS, Amyotrophic Lateral Sclerosis remedies

Clinic

• Also known as motor neuron disease (MND) or Lou Gehrig's disease
• It is a neurodegenerative disease that results in the progressive loss of motor neurons that control voluntary muscles.
• ALS is the most common type of motor neuron diseases.

There is debate over whether PLS and PMA are separate diseases or simply variants of ALS.

Progression

• Early symptoms of ALS include Stiff muscles / Muscle twitches / Gradual increasing weakness /Muscle wasting
• It progresses upwards leading to Dysphagia and Dyspnea / Unable to breathe / Respiratory failure.

• 50% develop at least mild difficulties with thinking and behavior
• 15% develop frontotemporal dementia.
• Most people experience pain.
• The affected muscles are responsible for chewing food, speaking, and walking.
• Motor neuron loss continues until the ability to eat, speak, move, and finally the ability to breathe is lost.

Etiology

• About 90% to 95% have no known cause, and are known as sporadic ALS. The remaining 5% to 10% of cases have a genetic cause linked to a history of the disease in the family, and these are known as familial

UMN or LMN

It causes symptoms of both upper and lower motor neuron syndrome.

• Upper motor neuron symptoms include spastic gait, dysphagia, dysarthria, and clonus.
• Lower motor neuron symptoms include muscle atrophy, weakness, and flaccidity.

ALS-FTD

• ALS and frontotemporal dementia (FTD) are considered to be part of a common disease continuum (ALS-FTD) because of genetic, clinical, and pathological similarities.
• The underlying mechanism involves damage to both upper and lower motor neurons; in ALS-FTD, neurons in the frontal and temporal lobes of the brain die as well.
• The diagnosis is based on a person's signs and symptoms, with testing done to rule out other potential causes.

ALS Classification

Classical ALS

• Typical / Classical ALS involves neurons in the brain (upper motor neurons) and in the spinal cord (lower motor neurons)
• Classic ALS accounts for about 70% of all cases of ALS and can be subdivided into
  • Limb-onset : ALS begins with weakness in the arms or legs. (66%)
  • Bulbar-onset : ALS begins with difficulty speaking or swallowing (25%)
  • Respiratory-onset ALS: It accounts for about 3% of all cases of ALS, in which the initial symptoms are difficulty breathing (dyspnea) with exertion, at rest, or while lying down (orthopnea).

PLS

• Primary lateral sclerosis (PLS) involves only upper motor neurons in Arms and Legs.
• It accounts for about 5% of all cases of ALS
• More than 75% of people with apparent PLS develop lower motor neuron signs within four years of symptom onset, meaning that a definite diagnosis of PLS cannot be made until then.
• PLS has a better prognosis than classic ALS, as it progresses slower, results in less functional decline, does not affect the ability to breathe, and causes less severe weight loss.

PMA

• Progressive muscular atrophy (PMA) involves only lower motor neurons.
• Progressive muscular atrophy (PMA) accounts for about 5% of all cases of ALS and affects lower motor neurons in the arms and legs.
• While PMA is associated with longer survival on average than classic ALS, it still progresses to other spinal cord regions over time, eventually leading to respiratory failure and death.
• Upper motor neuron signs can develop late in the course of PMA, in which case the diagnosis might be changed to classic ALS.

Regional variants

• Regional variants of ALS have symptoms that are limited to a single spinal cord region for at least a year;
• They progress more slowly than classic ALS and are associated with longer survival.
• Examples include flail arm syndrome,
• Flail Leg / Arm syndrome: They only involve lower motor neurons. Flail arm syndrome, also called brachial amyotrophic diplegia, is characterized by lower motor neuron damage in the cervical spinal cord only, leading to gradual onset of weakness in the proximal arm muscles and decreased or absent reflexes. Flail leg syndrome, also called leg amyotrophic diplegia, is characterized by lower motor neuron damage in the lumbosacral spinal cord only, leading to gradual onset of weakness in the legs and decreased or absent reflexes.
• Isolated bulbar ALS: Isolated bulbar ALS can involve upper or lower motor neurons. Isolated bulbar ALS is characterized by upper or lower motor neuron damage in the bulbar region only, leading to gradual onset of difficulty with speech (dysarthria) and swallowing (dysphagia); breathing (respiration) is generally preserved, at least initially.

Miasms

CJD

• UMN: Spasticity + Myoclonous + Hyper reflexia
• Bulbar: Dysphagia + Dysarthria
• LMN: Muscular atrophy + Fasciculation

PLV

• LMN: Muscular atrophy + Fasciculation + Flaccid paralysis + Hypo reflexia
• Bulabar paralysis: Dysphagia + Mouth speech difficult

TBE

• LMN (Muscular atrophy + Fasciculation + Flaccid paralysis)
• Emotinal lability

NVCJD

• UMN: Spasticity + Myoclonous + Hyper reflexia
• Bulbar: Dysphagia + Dysarthria

HTLV-1:

UMN: Spasticity + Myoclonous, Stiff gait + Hyper reflexia + Face exagerated jaw jerk

CXA:

Bulabar paralysis: Dysphagia + Respiratory failure

E70:

Bulabar paralysis: Respiratory failure

Signs and symptoms

• Muscle weakness, atrophy
• Muscle spasms throughout the body
• Losing the ability to initiate and control all voluntary movement, although bladder and bowel function and the extraocular muscles are usually spared until the final stages of the disease.
• Cognitive or behavioral dysfunction is present in 30–50%
• 10–15% will show signs of frontotemporal dementia (FTD)
• Repeating phrases or gestures, apathy, and loss of inhibition are frequently reported behavioral features of ALS.
• Language dysfunction, executive dysfunction, and troubles with social cognition and verbal memory are the most commonly reported
• About half the people who have ALS experience emotional lability, in which they cry or laugh for no reason; it is more common in those with bulbar-onset ALS.
• Pain esp neuropathic pain, spasticity, muscle cramps, and
• Nociceptive pain caused by reduced mobility and muscle weakness; examples of nociceptive pain in ALS include contractures (permanent shortening of a muscle or joint), neck pain, back pain, shoulder pain, and pressure ulcers.
• Sensory nerves and the autonomic nervous system are generally unaffected, meaning the majority of people with ALS maintain hearing, sight, touch, smell, and taste.

ACUTE DISEASES - Neurological disorders - amyotrophic lateral sclerosis : Ars , Kali-p , Lach , Merc , Phos , PLB , Sec , Sep , Sulph