Topzle Topzle

ALS

Updated: Wikipedia source

ALS

Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND) or—in the United States and Canada—Lou Gehrig's disease (LGD), is a rare, terminal neurodegenerative disorder that results in the progressive loss of both upper and lower motor neurons that normally control voluntary muscle contraction. ALS is the most common form of the broader group of motor neuron diseases. ALS often presents in its early stages with gradual muscle stiffness, twitches, weakness, and wasting. Motor neuron loss typically continues until the abilities to eat, speak, move, and breathe without mechanical support are lost. While only 15% of people with ALS also develop full-blown frontotemporal dementia, an estimated 50% face at least minor changes in thinking and behavior, and a loss of energy, possibly secondary to metabolic dysfunction, is thought to drive a characteristic loss of empathy. Depending on which of the aforementioned symptoms develops first, ALS is classified as limb-onset (begins with weakness in the arms or legs) or bulbar-onset (begins with difficulty in speaking and/or swallowing). Respiratory onset occurs in approximately 1%–3% of cases. Most cases of ALS (about 90–95%) have no known cause, and are known as sporadic ALS. However, both genetic and environmental factors are believed to be involved. The remaining 5–10% of cases have a genetic cause, often linked to a family history of the disease, and these are known as familial ALS (hereditary). About half of these genetic cases are due to disease-causing variants in one of four specific genes. The diagnosis is based on a person's signs and symptoms, with testing conducted to rule out other potential causes. There is no known cure for ALS. The goal of treatment is to slow the disease progression and improve symptoms. FDA-approved treatments that slow the progression of ALS include riluzole and edaravone. Non-invasive ventilation may result in both improved quality and length of life. Mechanical ventilation can prolong survival but does not stop disease progression. A feeding tube may help maintain weight and nutrition. Death is usually caused by respiratory failure. The disease can affect people of any age, but usually starts around the age of 60. The average survival from onset to death is two to four years, though this can vary, and about 10% of those affected survive longer than ten years. Descriptions of the disease date back to at least 1824 by Charles Bell. In 1869, the connection between the symptoms and the underlying neurological problems was first described by French neurologist Jean-Martin Charcot, who in 1874 began using the term amyotrophic lateral sclerosis.

Infobox

Other names
mw- Motor neurone disease (MND)Lou Gehrig's diseaseCharcot's disease
Specialty
Neurology
Symptoms
Early: Stiff muscles, muscle twitches, gradual increasing weakness Later: Difficulty in speaking, swallowing, and breathing; respiratory failure; 10–15% experience frontotemporal dementia
Complications
Falling (accident); Respiratory failure; Pneumonia; Malnutrition
Usual onset
45–75 years
Causes
Unknown (90% to 95%), genetic (5% to 10%)
Risk factors
Genetic risk factors; age; male sex; heavy metals; organic chemicals; smoking; electric shock; physical exercise; head injury
Diagnostic method
Clinical diagnosis of exclusion based on progressive symptoms of upper and lower motor neuron degeneration in which no other explanation can be found. Supportive evidence from electromyography, genetic testing, and neuroimaging
Differential diagnosis
Multifocal motor neuropathy, Kennedy's disease, Hereditary spastic paraplegia, Nerve compression syndrome, Diabetic neuropathy, Post-polio syndrome, Myasthenia gravis, Multiple sclerosis
Treatment
Walker (mobility); Wheelchair; Non-invasive ventilation; Feeding tubes; Augmentative and alternative communication; symptomatic management
Medication
Riluzole, Edaravone, Sodium phenylbutyrate/ursodoxicoltaurine, Tofersen, Dextromethorphan/quinidine
Prognosis
Life expectancy highly variable but typically 2–4 years after diagnosis
Frequency
Incidence: 1.6/100,000 individuals per year Prevalence: 4.4/100,000 living individuals Lifetime risk: 1 in 400 individuals

Tables

· Classification › Subtypes of motor neuron disease
Classical ALS
Classical ALS
Main ALS subtypes
Classical ALS
Upper motor neuron degeneration
Yes
Lower motor neuron degeneration
Yes
Primary lateral sclerosis (PLS)
Primary lateral sclerosis (PLS)
Main ALS subtypes
Primary lateral sclerosis (PLS)
Upper motor neuron degeneration
Yes
Lower motor neuron degeneration
No
Progressive muscular atrophy (PMA)
Progressive muscular atrophy (PMA)
Main ALS subtypes
Progressive muscular atrophy (PMA)
Upper motor neuron degeneration
No
Lower motor neuron degeneration
Yes
Main ALS subtypes
Upper motor neuron degeneration
Lower motor neuron degeneration
Classical ALS
Yes
Yes
Primary lateral sclerosis (PLS)
Yes
No
Progressive muscular atrophy (PMA)
No
Yes
Kings ALS staging system and prognosis at each stage · Signs and symptoms › Prognosis, staging, and survival
Stage description
Stage description
Col 1
Stage description
Stage 1
Symptom onset, involvement of the first region
Stage 2
2A: Diagnosis 2B: Involvement of the second region
Stage 3
Involvement of the third region
Stage 4
4A: Need for a feeding tube 4B: Need for non-invasive ventilation
Median time to stage
Median time to stage
Col 1
Median time to stage
Stage 1
13.5 months
Stage 2
17.7 months
Stage 3
23.3 months
Stage 4
4A: 17.7 months 4B: 30.3 months
Stage 1
Stage 2
Stage 3
Stage 4
Stage description
Symptom onset, involvement of the first region
2A: Diagnosis 2B: Involvement of the second region
Involvement of the third region
4A: Need for a feeding tube 4B: Need for non-invasive ventilation
Median time to stage
months
months
months
months 4B: 30.3 months
MiToS ALS staging system and prognosis at each stage · Signs and symptoms › Prognosis, staging, and survival
Stage description
Stage description
Col 1
Stage description
Stage 0
No loss of a functional domain
Stage 1
Loss of 1 domain
Stage 2
Loss of 2 domains
Stage 3
Loss of 3 domains
Stage 4
Loss of 4 domains
Stage 5
Death
Probability of death at each stage
Probability of death at each stage
Col 1
Probability of death at each stage
Stage 0
7%
Stage 1
26%
Stage 2
33%
Stage 3
33%
Stage 4
86%
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
Stage description
No loss of a functional domain
Loss of 1 domain
Loss of 2 domains
Loss of 3 domains
Loss of 4 domains
Death
Probability of death at each stage
7%
26%
33%
33%
86%

References

  1. Orphanet Journal of Rare Diseases
    https://doi.org/10.1186%2F1750-1172-4-3
  2. European Journal of Neurology
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540334
  3. "Amyotrophic Lateral Sclerosis (ALS) Fact Sheet"
    https://www.ninds.nih.gov/health-information/disorders/amyotrophic-lateral-sclerosis-als
  4. Muscle & Nerve
    https://doi.org/10.1002%2Fmus.27567
  5. Nature Reviews. Neurology
    http://eprints.whiterose.ac.uk/104445/1/16.pdf
  6. The Lancet. Neurology
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9513753
  7. JAMA Neurology
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6646974
  8. www.ninds.nih.gov
    https://web.archive.org/web/20201010105651/https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Motor-Neuron-Diseases-Fact-Sheet
  9. Neurology
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6177274
  10. Lancet
    https://doi.org/10.1016%2FS0140-6736%2817%2931287-4
  11. Nature Reviews. Disease Primers
    http://eprints.whiterose.ac.uk/122838/1/WR_ALS-Hardiman_V3_EDITED_FOR_AUTHOR_APPROVAL_FINAL_APPROVED-1.pdf
  12. "Understanding ALS"
    https://www.als.org/understanding-als
  13. PLOS ONE
    https://doi.org/10.1371%2Fjournal.pone.0027985
  14. MedlinePlus Genetics
    https://medlineplus.gov/genetics/condition/amyotrophic-lateral-sclerosis/
  15. The Lancet. Neurology
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9513754
  16. The ALS Association
    https://www.als.org/navigating-als/living-with-als/fda-approved-drugs
  17. Revue Neurologique
    https://doi.org/10.1016%2Fj.neurol.2017.03.031
  18. The Lancet. Neurology
    https://doi.org/10.1016%2FS1474-4422%2814%2970221-2
  19. Lancet
    https://doi.org/10.1016%2Fs0140-6736%2810%2961156-7
  20. Annals of Neurology
    https://doi.org/10.1002%2Fana.24096
  21. Archives of Neurology
    https://doi.org/10.1001%2Farchneur.58.3.512
  22. ICD-11 for Mortality and Morbidity Statistics
    https://icd.who.int/browse/2024-01/mms/en#661720689
  23. Brain Sciences
    https://doi.org/10.3390%2Fbrainsci11121597
  24. Cold Spring Harbor Perspectives in Medicine
    https://doi.org/10.1101%2Fcshperspect.a024117
  25. StatPearls
    https://www.ncbi.nlm.nih.gov/books/NBK560774/
  26. Amyotrophic Lateral Sclerosis
    https://doi.org/10.3109%2F17482960903426543
  27. Nature Reviews. Neurology
    https://lirias.kuleuven.be/handle/123456789/469667
  28. The Lancet. Neurology
    https://doi.org/10.1016%2FS1474-4422%2816%2930199-5
  29. Neurologic Clinics
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629514
  30. BMC Neurology
    https://doi.org/10.1186%2Fs12883-021-02438-8
  31. Journal of Neurology, Neurosurgery & Psychiatry
    https://jnnp.bmj.com/content/90/3/268
  32. Genes
    https://doi.org/10.3390%2Fgenes12121935
  33. Neural Plasticity
    https://doi.org/10.1155%2F2017%2F6509493
  34. Revue Neurologique
    https://doi.org/10.1016%2Fj.neurol.2017.03.029
  35. Amyotrophic Lateral Sclerosis & Frontotemporal Degeneration
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3779649
  36. "Motor neurone disease"
    https://www.nhs.uk/conditions/motor-neurone-disease/
  37. The Lancet. Neurology
    https://arxiv.org/abs/1607.02870
  38. Annals of Clinical and Translational Neurology
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359118
  39. Journal of the Neurological Sciences
    https://doi.org/10.1016%2Fs0022-510x%2899%2900210-5
  40. Brain Communications
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8659356
  41. Journal of Neurology
    https://doi.org/10.1007%2Fs00415-014-7564-8
  42. Neurology
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4239834
  43. Neurology
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4793781
  44. Amyotrophic Lateral Sclerosis
    https://doi.org/10.3109%2F17482960903093710
  45. Frontiers in Neurology
    https://doi.org/10.3389%2Ffneur.2019.00106
  46. Journal of Neurologic Physical Therapy
    https://doi.org/10.1097%2FNPT.0b013e31819912d0
  47. Neurology Research International
    https://doi.org/10.1155%2F2011%2F714693
  48. Neurology
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745736
  49. The European Respiratory Journal
    https://doi.org/10.1183%2F13993003.00261-2019
  50. Journal of Neurology, Neurosurgery, and Psychiatry
    https://epub.ub.uni-muenchen.de/21892/
  51. Amyotrophic Lateral Sclerosis
    https://doi.org/10.1080%2F17482960701656940
  52. Amyotrophic Lateral Sclerosis & Frontotemporal Degeneration
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5425622
  53. Journal of Neurology, Neurosurgery, and Psychiatry
    https://hal.archives-ouvertes.fr/hal-00623289/file/PEER_stage2_10.1136%252Fjnnp.2010.235952.pdf
  54. "Stephen Hawking serves as role model for ALS patients"
    http://www.cnn.com/2009/HEALTH/04/20/hawking.als/index.html
  55. F1000Research
    https://doi.org/10.12688%2Ff1000research.10476.1
  56. Neurology
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6177274
  57. Journal of Neurology, Neurosurgery, and Psychiatry
    https://doi.org/10.1136%2Fjnnp-2020-325701
  58. Acta Psychiatrica Scandinavica
    https://doi.org/10.1111%2Fj.1600-0447.2007.01025.x
  59. CNS Spectrums
    https://doi.org/10.1017%2FS1092852916000791
  60. Amyotrophic Lateral Sclerosis
    https://doi.org/10.3109%2F17482968.2012.656652
  61. Revue Neurologique
    https://doi.org/10.1016%2Fj.neurol.2017.04.001
  62. Nature Neuroscience
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544832
  63. Journal of Neurology, Neurosurgery, and Psychiatry
    https://doi.org/10.1136%2Fjnnp-2015-310734
  64. Nature Reviews. Neurology
    https://doi.org/10.1038%2Fnrneurol.2013.203
  65. Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/amyotrophic-lateral-sclerosis/symptoms-causes/syc-20354022
  66. The ALS Association
    https://www.als.org/understanding-als/who-gets-als
  67. The Neuroscientist
    https://eprints.qut.edu.au/110861/2/UQ351652_OA.pdf
  68. European Journal of Human Genetics
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9177585
  69. Amyotrophic Lateral Sclerosis & Frontotemporal Degeneration
    https://doi.org/10.1080%2F21678421.2022.2150556
  70. SOD1
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8784989
  71. Brain
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9762932
  72. Brain
    https://academic.oup.com/brain/article/145/4/1207/6501632
  73. Neurotoxicology
    https://linkinghub.elsevier.com/retrieve/pii/S0161813X16301164
  74. Frontiers in Public Health
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10694508
  75. Amyotrophic Lateral Sclerosis
    https://doi.org/10.1080%2F14660820510012004
  76. Brain and Behavior
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6192405
  77. Brain and Behavior
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5256182
  78. Annual Review of Neuroscience
    https://www.annualreviews.org/content/journals/10.1146/annurev-neuro-082823-020615
  79. Knowable Magazine
    https://knowablemagazine.org/content/article/health-disease/2025/awakened-viral-jumping-genes-role-in-alzheimers-als
  80. Nature Reviews. Neuroscience
    https://doi.org/10.1038%2Fnrn3430
  81. The New England Journal of Medicine
    https://kclpure.kcl.ac.uk/portal/en/publications/amyotrophic-lateral-sclerosis(70a10b6b-0121-46ae-896b-7108a6666dcb).html
  82. Neuropathology
    https://doi.org/10.1111%2Fj.1440-1789.2007.00873.x
  83. Marine Drugs
    https://doi.org/10.3390%2Fmd14050102
  84. Acta Neuropathologica Communications
    https://doi.org/10.1186%2Fs40478-020-01018-0
  85. Disease Models & Mechanisms
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5451175
  86. Degenerative Neurological and Neuromuscular Disease
    https://doi.org/10.2147%2FDNND.S84956
  87. Brain Research
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003642
  88. Molecular Neurodegeneration
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10018954
  89. Trends in Genetics
    https://doi.org/10.1016%2Fj.tig.2018.03.001
  90. Brain Research
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003651
  91. Acta Neuropathologica
    https://doi.org/10.1007%2Fs00401-020-02252-5
  92. Frontiers in Neurology
    https://doi.org/10.3389%2Ffneur.2019.00291
  93. PM&R
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590769
  94. Archives Italiennes de Biologie
    https://doi.org/10.4449%2Faib.v149i1.1260
  95. "Lambert-Eaton Myasthenic Syndrome (LEMS)"
    http://misc.medscape.com/pi/android/medscapeapp/html/A1170810-business.html
  96. LEMS.com
    https://web.archive.org/web/20130120025113/http://www.lems.com/what_is_lems
  97. Brain
    https://doi.org/10.1093%2Fbrain%2Fawq290
  98. The Cochrane Database of Systematic Reviews
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485636
  99. Sleep Medicine Reviews
    https://doi.org/10.1016%2Fj.smrv.2015.05.007
  100. Progress in Neurobiology
    https://doi.org/10.1016%2Fj.pneurobio.2013.05.001
  101. NeuroRehabilitation
    https://doi.org/10.3233%2FNRE-2007-22608
  102. "Amyotrophic Lateral Sclerosis (ALS)"
    https://web.archive.org/web/20120802064043/http://www.asha.org/public/speech/disorders/ALS/
  103. British Medical Bulletin
    https://doi.org/10.1093%2Fbmb%2Fldp049
  104. The American Journal of Occupational Therapy
    https://doi.org/10.5014%2Fajot.2014.008649
  105. The Cochrane Database of Systematic Reviews
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10413437
  106. European Journal of Neurology
    https://doi.org/10.1111%2Fj.1468-1331.2011.03501.x
  107. The Cochrane Database of Systematic Reviews
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055506
  108. Archives Italiennes de Biologie
    https://doi.org/10.4449%2Faib.v149i1.1267
  109. The Lancet. Neurology
    https://doi.org/10.1016%2FS1474-4422%2817%2930115-1
  110. Therapeutic Advances in Neurological Disorders
    https://doi.org/10.1177%2F1756285617734734
  111. Amyotrophic Lateral Sclerosis & Frontotemporal Degeneration
    https://doi.org/10.1080%2F21678421.2017.1353101
  112. "FDA Approves Oral Form for the treatment of adults with amyotrophic lateral sclerosis (ALS)"
    https://web.archive.org/web/20220512203805/https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-oral-form-treatment-adults-amyotrophic-lateral-sclerosis-als
  113. The ALS Association
    https://www.als.org/navigating-als/living-with-als/fda-approved-drugs/amx0035
  114. AP News
    https://apnews.com/article/relyvrio-amylyx-als-drug-fda-5fca44189f7e33f7645cb8d019197442
  115. A Phase III, Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial to Evaluate the Safety and Efficacy of AMX0035 Versus Placebo for 48-week Treatment of Adult Patients With Amyotrophic Lateral Sclerosis (ALS)
    https://clinicaltrials.gov/study/NCT05021536
  116. "FDA approves treatment of amyotrophic lateral sclerosis associated with a mutation in the SOD1 gene"
    https://web.archive.org/web/20230425172813/https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-treatment-amyotrophic-lateral-sclerosis-associated-mutation-sod1-gene
  117. SOD1
    https://doi.org/10.1056%2FNEJMoa2204705
  118. Neurology
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456658
  119. JAMA Network Open
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851239
  120. "Novel Agent Safe in ALS, Phase II Study Suggests"
    https://www.medpagetoday.com/neurology/generalneurology/114420
  121. NeuroRehabilitation
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223769
  122. Neurodegenerative Disease Management
    https://doi.org/10.2217%2Fnmt.13.74
  123. Muscle & Nerve
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4433000
  124. Journal of Neurologic Physical Therapy
    https://doi.org/10.1097%2FNPT.0000000000000136
  125. Acta Neurologica Scandinavica
    https://doi.org/10.1111%2Fj.1600-0404.2009.01290.x
  126. Molecular Epidemiology: Principles and Practices
  127. Neuroepidemiology
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049265
  128. Journal of Neurology, Neurosurgery, and Psychiatry
    https://kclpure.kcl.ac.uk/portal/en/publications/the-changing-picture-of-amyotrophic-lateral-sclerosis(93e2a283-3125-4464-88ed-009897be906c).html
  129. MMWR. Morbidity and Mortality Weekly Report
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858037
  130. Nature Communications
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987527
  131. Revue Neurologique
    https://doi.org/10.1016%2Fj.neurol.2017.03.035
  132. Journal of Neurology, Neurosurgery, and Psychiatry
    https://doi.org/10.1136%2Fjnnp-2016-315018
  133. Arquivos de Neuro-Psiquiatria
    https://doi.org/10.1590%2F0004-282X20160040
  134. Neurology
    https://doi.org/10.1212%2F01.wnl.0000302187.20239.93
  135. Clinical Neurophysiology Practice
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10776891
  136. Neurology
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821838
  137. Journal of the Neurological Sciences
    https://doi.org/10.1016%2Fs0022-510x%2898%2900194-4
  138. Journal of the Neurological Sciences
    https://doi.org/10.1016%2F0022-510x%2894%2990191-0
  139. Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders
    https://doi.org/10.1080%2F146608200300079536
  140. Clinical Neurophysiology
    https://doi.org/10.1016%2Fj.clinph.2007.09.143
  141. Clinical Neurophysiology
    https://doi.org/10.1016%2Fj.clinph.2020.04.005
  142. The ALS Association
    http://www.alsa.org/about-als/what-is-als.html
  143. Muscular Dystrophy Association
    https://www.mda.org/disease/amyotrophic-lateral-sclerosis
  144. Muscle & Nerve
    https://doi.org/10.1002%2F%28SICI%291097-4598%28200003%2923%3A3%3C336%3A%3AAID-MUS4%3E3.0.CO%3B2-L
  145. Amyotrophic Lateral Sclerosis
  146. Aging and Disease
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3794725
  147. Clinical Neurophysiology
    https://doi.org/10.1016%2Fj.clinph.2016.04.025
  148. The Independent
    https://web.archive.org/web/20140821095115/http://www.independent.co.uk/news/people/george-bush-delivers-possibly-the-best-als-ice-bucket-challenge-yet-9680934.html
  149. Amyotrophic Lateral Sclerosis & Frontotemporal Degeneration
    https://doi.org/10.3109%2F21678421.2014.984725
Image
Source:
Tip: Wheel or +/− to zoom, drag to pan, Esc to close.