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# Amyotrophic lateral sclerosis

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Amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease) is a disorder characterized by the progressive loss of voluntary muscle contraction due to the destruction of nerve cells in the brain and the spinal cord that are responsible from the stimulation of the voluntary muscles.

The muscles are simply stimulated by a group of neurons located on the frontal portion of the spinal cord projecting to the muscle cells (second motor neurons) and these nerve cells are stimulated by a group of nerve cells that project from a specific region called motor area located on the frontal lobe (first motor neurons). The latter projection is called the corticospinal tract. The nerve cells of both pathways shrink and die for some unknown reason giving rise to muscle weakness, muscle cramps, speech impairment, difficulty swallowing and breathing.

ALS is indeed the most frequently observed member of a family of disorders called motor neuron diseases. This family has three major subgroups called primary lateral sclerosis (only the first motor neurons are affected), spinal muscular atrophy (only the second motor neurons are affected) and ALS (both are affected).

The incidence of ALS is approximately 1 out of 100000 people, males are affected slightly more than women, the onset of symptoms is usually after the 5th or 6th decade and there are also familial forms of the disease.

The diagnosis is established on both clinical grounds and an electromyography examination, which is obligatory to demonstrate the diffuse loss of nervous stimulation of muscles of extremities, face and abdomen. Neuroimaging examinations can be performed for some occasional cases especially for a mass lesion of upper parts of spinal cord to exclude some disorders that may mimic the symptoms of ALS. The disease has always a grave prognosis and the patients usually die within 2 to 10 years. There is no definite cure and the treatment is usually supportive and symptomatic.

Some cases with familial forms of the disease were shown to have a mutation on their superoxide dismutase (SOD) 1 genes, which produces an enzyme that reduces the oxidative stress of the nerve cells. Similar findings led the researchers to assume that the nerve cell death was caused due an excess increase of free radicals in the cell. This hypothesis is one of many others developed to describe the etiology of ALS and is waiting to be reliably proven. Meanwhile, some experimental drugs are used to reduce the oxidative stress of the cells with very limited success.

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Last edited May 13, 2001 2:07 pm (diff)
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