Neurological Conditions

Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic lateral sclerosis is a progressive neurodegenerative disease affecting motor neurons—the nerve cells that control voluntary muscle movement. Symptoms and rate of progression vary between people.

Brain, spinal cord, and motor neuron pathway illustrated in a calm clinical editorial style
ALS affects the motor-neuron pathways that carry signals from the brain and spinal cord to voluntary muscles.

Motor neurons

How ALS affects movement

As motor neurons degenerate, muscles receive fewer signals and become weak. Onset may begin in a limb or in muscles involved in speech and swallowing. ALS can eventually affect mobility, communication, swallowing, and breathing.

  • progressive muscle weakness
  • muscle cramps, twitching, stiffness, or wasting
  • speech or swallowing difficulty in bulbar-onset disease
  • breathing-muscle involvement as disease progresses
  • sensation is generally not the primary system affected
Educational pathway from motor cortex through spinal cord and peripheral motor nerve to skeletal muscle
Upper and lower motor neurons work together to control voluntary movement.

Specialist evaluation

Diagnosis

There is no single definitive test for ALS. Neurologists use history, repeated neurological examination, electromyography and nerve-conduction studies, imaging, laboratory tests, and sometimes genetic testing to support diagnosis and exclude other conditions.

Management and support

Multidisciplinary care

Treatment may include disease-modifying medicines for eligible people and coordinated management of mobility, cramps, stiffness, saliva, nutrition, communication, breathing, sleep, mood, and caregiver needs. Physical, occupational, speech-language, respiratory, nutrition, psychological, palliative, and assistive-technology specialists may contribute.

Communication devices, mobility equipment, nutritional support, and non-invasive ventilation can support independence, comfort, and participation. Care planning should follow the person’s goals and preferences.

Careful communication

Research and prognosis

ALS is progressive and life-limiting, but individual course varies. Prognosis should be discussed with an ALS specialist who understands the person’s pattern, health, treatment options, and priorities. Research continues into disease mechanisms, biomarkers, genetics, and new therapies.

Authoritative references

Medical education sources

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