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ALS Progression

Although Amyotrophic Lateral Sclerosis (ALS) progresses differently in each individual, it usually follows a predictable pattern of muscle weakness and loss of motor function. This brings new challenges to patients and caregivers, which is why it is crucial to understand how ALS usually develops to prepare for the changes ahead.

Early Stages of ALS

Early diagnosis of ALS is difficult because the early symptoms are frequently subtle and similar to symptoms of other conditions, or can be mistaken as general symptoms of aging. Common early symptoms consist of:

  • Muscle weakness, which usually starts in the hands, feet, or limbs
  • Difficulties swallowing or speaking clearly
  • Muscle twitches
  • Muscle cramps and stiffness in muscles

Although symptoms may not be very noticeable in the early stages, they will become more obvious as the disease progresses and begins to affect the patient's day-to-day activities.

Middle Stages of ALS

When the disease reaches its middle stage, the ALS symptoms get progressively worse and start to have a major influence on daily activities. Patients might experience symptoms such as:

  • Increased muscle weakness, which can affect mobility
  • Difficulty standing or walking
  • Increased difficulty speaking and swallowing
  • Difficulties breathing as respiratory muscles weaken

At this stage, mobility assistance devices like wheelchairs, walkers, or braces may be necessary. Problems with communication can be assisted by speech therapy and other alternative communication techniques.

Advanced Stages of ALS

In the advanced stages of ALS, patients usually face severe disabilities:

  • Paralysis due to increased muscle weakness, which has spread over several parts of the body
  • Severe difficulties with speech and swallowing, possibly requiring feeding tubes
  • Respiratory failure is the most frequent cause of death in ALS patients. The patients often require ventilator support to assist breathing.

In this stage, palliative care becomes the primary focus of caregiving. The emphasis is set on maintaining the comfort and quality of life of the patient.

Rate of Progression

The progression rate of ALS can differ significantly among people.  While some individuals with ALS live for several years, the disease of others can progress more quickly. Several factors can influence the rate of progression, including the age of onset and specific genetic factors.

Managing ALS Progression

Although there is no cure for ALS yet, there are treatments that can help control symptoms and increase quality of life. Drugs like Edaravone and Riluzole have been shown to slow the course of the disease. Several therapies, such as physical, respiratory, and speech therapy, and nutritional guidance are essential to keep patients comfortable and healthy.

The journey with ALS is difficult for the person with the diagnosis and their loved ones. Making informed choices regarding home care and treatment requires an understanding of what ALS is, and especially how ALS progresses to prepare for future battles. 

Stages of ALS
Amyotrophic lateral sclerosis (ALS)
ALS and Palliative Care

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