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ALS


             Amyotrophic Lateral Sclerosis known as Lou Gehrig's disease is a fatal, degenerative disease of the nervous system. ALS affects the brain cells that carry impulses from the brain and spinal cord to the muscles. This disorder results in muscular weakness and the progressive wasting of muscles due to the loss of nerve supply. A combination of both upper and lower motor neuron involvement causes muscle atrophy, muscle twitching, and spasticity.
             The pathology and etiology of ALS is unknown which makes for a long, difficult process of elimination when attempting to diagnosis this condition. This process may include tests such as MRI, EMG, and blood tests. Although, these tests will not give a definite diagnosis of ALS, they will rule out the possibility of other similar conditions.
             There are typically two categories ALS patients may fall into. Progressive bulbar palsy also known as bulbar ALS is one category, which affects the upper motor neurons and cortico spinal processes. This category usually affects the muscles of the tongue, jaw, face, and larynx. The other category is termed progressive spinal muscular atrophy or limb-onset ALS, which affects the lower motor neurons. The typical muscles affected in this category are the arms and legs.
             When patients present with bulbar onset ALS, their symptoms are typically dysarthria (speech problems), sialorrhea (drooling), and emotional incontinence. These symptoms will progressively get worse and may cause the patient to have difficulty eating without aspiration of food or liquid into the lungs. This may require patient to have a feeding tube inserted. The patient is also at risk for respiratory failure which may require a need for an assisted breathing device or ventilator. Bulbar ALS also eventually affects the limbs causing weakness of the muscles and fasciculations. The bulbar onset ALS patients generally have a faster disease progression than limb-onset patients.


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