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Published by Isabel Garcia

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Categories:Types, School Work
Published by: Isabel Garcia on Feb 13, 2013
Copyright:Attribution Non-commercial


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 Jason, 50, was playing soccer with his son when he tripped severaltimes on the field while passing the ball. Later, his legs were trem- bling. He thought at first that he was just getting older; however,several months later, he felt his arm twitch slightly and he devel-oped left foot drop. This time, he knew that something was wrong.He went to his healthcare provider, who sent him to a neurologist.He was scheduled for magnetic resonance imaging (MRI) and anelectromyogram (EMG). His neurologist said that there could beseveral possible causes for his symptoms, two of which were amyo-trophic lateral sclerosis (ALS) and multiple sclerosis (MS). What’sthe difference between these two degenerative diseases?In this article, I’ll discuss the characteristics, causes, signs andsymptoms, diagnosis, and nursing interventions for both diseases.First, let’s review the characteristics of ALS.
28Nursing made Incredibly Easy!
May/June 2010 www.NursingMadeIncrediblyEasy.com
Degenerative disorders
Amyotrophic lateral sclerosis and multiplesclerosis are both degenerative diseases thatcause significant physical disability. Differentialdiagnosis is often difficult, so it’s important tounderstand the characteristics of both disor-ders and their treatment options. We tell youwhat you need to know.
By Margaret J. McCormick, MS, RNClinical Assistant Professor, Nursing • Towson University • Towson, Md.
The author has disclosed that she has no significant relationships with or financial interest in anycommercial companies that pertain to this educational activity.
www.NursingMadeIncrediblyEasy.com May/June 2010
Nursing made Incredibly Easy!29
What’s ALS?
ALS, better known as Lou Gehrig disease, isa progressive neuromuscular disorder thatinvolves the degeneration of both the upperand lower motor neurons, leading to even-tual wasting and atrophy of all voluntarymuscles, including the respiratory muscles(see
What happens in ALS
). The term amyo-trophic means without muscle nutrition orprogressive muscle wasting. This accountsfor the lower motor neuron component of the syndrome. Lateral sclerosis is the scar-ring of the corticospinal tract in the lateralcolumn of the spinal cord and refers to theupper motor neuron part of the syndrome.ALS is a fatal disease, with an average lifeexpectancy after diagnosis of 2 to 5 years.Most patients die of respiratory failure.ALS is a diffuse disease, but its onset isfocal and asymmetric. There are three differ-ent subtypes:
 progressive muscular atrophy
—onlylower motor neurons are involved
 primary lateral sclerosis
—only uppermotor neurons are involved
 progressive bulbar palsy
—restricted to bulbar muscles (rare). (Most patients whopresent with initial involvement of bulbarmuscles evolve to classic ALS, involving both upper and lower motor neurons.)Approximately 5,600 people in the UnitedStates are diagnosed with ALS each year.The incidence is 2 per 100,000 people. It’sestimated that 30,000 Americans have thedisease at any given time. The incidence of ALS is higher in men than in women untilmenopause, with a peak onset of symptoms between ages 40 and 60.
Cause and effect
There’s no single cause of ALS. Ten percentof diagnosed patients have a familial formof ALS. The genetic defect is thought to beon chromosome 21 and is involved with theenzyme glutamate. Coded to help destroyfree radicals, this enzyme is altered. Gluta-mate toxicity is now believed to be one of the possible causes or contributors to majorneuronal degeneration.
Signs and symptoms
ALS involves a slow, chronic progression of symptoms. The onset of symptoms varieswith each patient. One of the first symp-toms is usually unexplained weakness ina limb. The patient may notice wrist dropinterfering with his work or activities of daily living. He may complain of reducedfinger dexterity, cramping, or stiffness. Hemay develop foot drop that results in a fallor sprain. It’s the combination of a weak,
Nursing made Incredibly Easy!
May/June 2010 www.NursingMadeIncrediblyEasy.com
What happens in ALS
• Progressive weakness and wasting of muscles of the arms, trunk, andlegs• Fasciculations and signs of spasticity• Progressive difficulty swallowing (drooling and regurgitation of liquidsthrough nose), speaking (nasal and unintelligible) and, ultimately, breathing• Cranial nerve deficits (bulbar symptoms) are present in 20% of cases(prevalence increases with age), along with dysarthria, voice deterioration,and dysphagia
muscleatrophiedmuscleNormal nerve celland muscleALS-affected nervecell and muscleMotoneuronAxonCell body

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