FEATURE: TERI CAPRIOTTI, DO, MSN, CRNP; ERIN DONNELLY; SIMONE BRISSENDEN
Amyotrophic lateral sclerosis: update for the primary care clinician Patients with ALS require multidisciplinary care and rehabilitative interventions; maximizing independent function and quality of life are the goals.
© ISM / PR J.J. HAUW / MEDICALIMAGES.COM
Motor neuron from the spinal cord containing an inclusion from ALS.
A
myotrophic lateral sclerosis (ALS), which is often referred to as Lou Gehrig’s disease, is a progressive neurodegenerative disorder that is characterized by a loss of upper and lower motor neurons. Muscle weakness and atrophy develop gradually over many years. Often, the diagnosis is delayed because of the vague symptomatology, and primary care clinicians may be the first healthcare providers whom patients consult. Primary care clinicians should refer patients with suspected neurodegenerative symptoms to a neurologist, preferably one who specializes in movement disorders. Primary care clinicians may also be involved in palliative care and symptom management as the disease process progresses. Frequently, primary care clinicians are also a source of education and support for the caregivers of patients with ALS. It is difficult to estimate the incidence and prevalence of ALS because it is not a reportable disease. According to the Mehta et al, the estimated incidence of ALS across all ages is approximately 4 to 5 persons per 100,000.1 ALS is diagnosed each year in the United States in an estimated 5000 persons, with an estimated prevalence of 12,000 to 15,000 cases.ALS is more prevalent in men than in women, with a typical age at diagnosis of 55 to 75 years.1,2
Etiology
The etiology of ALS is unknown, but some risk factors have been proposed, including genetic predisposition, toxic effects of heavy metal, viral infection, environmental and occupational exposures, www.ClinicalAdvisor.com • THE CLINICAL ADVISOR • JUNE 2018 15