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Amyotrophic Lateral Sclerosis (ALS)

amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis is a disease characterized by damage and death of cells in the brain and spinal cord. As a result, muscle weakness and paralysis (immobility) develop. The manifestations of the disease are gradually increasing. Patients lose the ability to move independently, the activity of the muscles necessary for breathing is disrupted, which leads to the death of patients. 

The causes of the disease are not fully understood. There are several factors that influence the onset of the disease.  These include genetic mutations (changes in genetic material), imbalances of certain chemicals in the nervous system, disorders in the immune system (the system that protects the body from various infections), and others. 

Amyotrophic lateral sclerosis affects the neurons of the motor (motor) fields of the cerebral cortex, as well as the motor neurons of the anterior and lateral horns (columns) of the spinal cord. Thus, the structural zones and sections of the central nervous system that are responsible for muscle tone, regulation, and control of muscle activity in the widest spectrum, from the tension of the powerful muscles of the limbs, back, abdominal wall – to facial, respiratory, articulatory movements, thin finger motor skills, etc.

The first symptoms of the disease. Forms of ALS 

The first symptoms of the disease ALS

Early symptoms of amyotrophic lateral sclerosis include twitching, muscle cramps and numbness, weakness in the limbs, and difficulty speaking. These disorders are characteristic of many other neurological diseases. Therefore, the diagnosis of amyotrophic lateral sclerosis is difficult – until the disease develops to the stage of muscle atrophy. In the pathogenesis of amyotrophic lateral sclerosis, increased activity of the glutamatergic system plays a key role, while an excess of glutamic acid causes overexcitation and death of neurons. Each fibrillar twitching of the muscle corresponds to the death of one motor neuron in the spinal cord, which means that this part of the muscle loses its innervation, it will no longer be able to contract normally and will atrophy. 

The classification of amyotrophic lateral sclerosis currently includes the following forms: 

  • Limb-onset ALS (up to three-quarters of patients) begins, as a rule, with the defeat of one or both legs. Patients feel awkward when walking, ankle stiffness, stumble. Lesions of the upper extremities are less common, and it is difficult to perform normal activities that require the flexibility of the fingers or effort of the hand;
  • Bulbar-onset ALS is manifested by difficulty in speech (the patient speaks “through the nose,” poorly controls the volume of speech, later experiences difficulty in swallowing). 

Causes of ALS

The cause of the disease is currently unknown. Although numerous risk factors for the disease have been identified, most of which are largely unsupported by empirical evidence. The most important factors are genetics and exposure to heavy metals or chemicals.

ALS presents two forms of appearance:

  1. Sporadic ALS: its occurrence is completely random. No risk factor can be identified.
  2. Familial ALS: This is an inherited variant with an autosomal dominant profile. It accounts for 5 to 10% of cases. Because of this, it cannot be considered a hereditary disease.

In the absence of family history, the occurrence of the case is considered sporadic and therefore the patient’s relatives do not pose a greater risk than the rest of the population with the condition. 

Diagnostics of amyotrophic lateral sclerosis

Diagnostics of amyotrophic lateral sclerosis

When some of the first symptoms of ALS appear, you should see your doctor, who will refer you to a neurologist if necessary. But even a timely visit to a neurologist ensures that the diagnosis is made as soon as it takes some time to verify the diagnosis. 

The neurologist will be interested in medical history and neurological status:

  • Reflexes
  • Muscle strength
  • Muscle tone
  • Coordination

Amyotrophic lateral sclerosis is difficult to diagnose in the early stages since the symptoms are similar to other neurological diseases. The following diagnostic methods are used:

  • Electroneuromyography. This method measures electrical potentials in muscles and the conduction of impulses along nerve fibers and muscle. Electroneurography allows you to investigate the conduction along nerve fibers. For this test, electrodes are attached to the skin over the nerve or muscle to be examined. A small electric current is passed through the electrodes and the speed of the pulse is determined.
  • MRI. This method uses a powerful magnetic field and allows detailed visualization of various tissues, including nerve ones.
  • Blood and urine tests. Laboratory testing of blood and urine samples can help the doctor rule out other possible causes of the symptom.
  • Muscle biopsy. If a muscle disorder is suspected, a muscle biopsy may be done. In this procedure, a piece of muscle tissue is taken under local anesthesia. The tissue sample is then sent for examination. 

ALS treatment

Until now, there is no treatment that could stop or slow down the progression of the pathological process in ALS. Riluzole is the only drug that has shown some effectiveness in this disease, but it can only be taken as directed by a doctor. New treatments for this disease are being researched around the world. 

Despite the lack of effective treatment, all ALS symptoms can be corrected to one degree or another. The most important is the correction of swallowing and breathing disorders since they pose an immediate threat to life.

For the treatment of patients with swallowing disorders, the most often used is the insertion of a gastrostomy tube, a special tube that allows food to be injected directly into the stomach. Less often, a nasogastric tube is inserted or a switch to parenteral nutrition is performed. Providing adequate nutrition is extremely important and, most importantly, helps in ALS treatment. Control of salivation is also of great importance.

They usually use such methods as non-invasive or invasive ventilation of the lungs, diaphragm stimulation to solve breathing problems. It has been shown that ensuring adequate breathing can prolong the life of patients.

Muscle cramps, drooling, pain, depression, and many others problems can be resolved with appropriate symptomatic treatment, including special medications or physical therapy. Psychological support of the patient and his family members is of great importance at all stages of the disease, from the diagnosis to the final stages.


Rehabilitation ALS

Patients with amyotrophic lateral sclerosis need, first of all, motor rehabilitation – exercises aimed at training muscles that are not affected by the disease. The regular exercise aimed at increasing overall physical strength allows the patient to:

  • overcome the movement defects that the progression of the disease brings as long as possible;
  • maintain muscle tone;
  • prevent the development of contractures (limitation of movement in the joints).

In connection with the progression of the disease at a certain stage, habilitation is necessary – measures to adapt to life in the conditions of the disease. The most important role in prolonging the life of ALS patients is played by correct work with breathing and swallowing disorders, prevention of aspiration pneumonia, which, is the main cause of death of ALS patients. 

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Lone Star Neurology
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Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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