Approximately 3. 0,0. Americans currently have the disease. The annual incidence rate is one to two cases per 1. The disease is most commonly diagnosed in middle age and affects more men than women. It usually presents with problems in dexterity or gait resulting from muscle weakness. Difficulty in speaking or swallowing is the initial symptom in the bulbar form of the disease. Over a period of months or years, patients with ALS develop severe, progressive muscular weakness and other symptoms caused by loss of function in both upper and lower motor neurons. Sphincter control, sensory function, intellectual abilities and skin integrity are preserved. Patients become completely disabled, often requiring ventilatory support and gastrostomy. Death usually occurs within five years of diagnosis and is attributed to respiratory failure or cachexia. The etiology of the disease is unknown. Current research is focused on abnormalities of neuronal cell metabolism involving glutamate and the role of potential neurotoxins and neurotrophic factors. New drugs are being developed based on these theories. Current management involves aggressive, individualized alleviation of symptoms and complications. WALLING, M. D., University of Kansas School of Medicine, Wichita, Kansas Physician reviewed scopolamine (oral) patient information - includes scopolamine description, dosage and directions. Scopolamine(Isopto Hyoscine) generic is an anticholinergic agent, prescribed for prevention of symptoms of motion sickness such as nausea and vomiting, and recovery. Americans currently have the disease. The annual incidence rate is one to two cases per 1. The disease is most commonly diagnosed in middle age and affects more men than women. It usually presents with problems in dexterity or gait resulting from muscle weakness. Difficulty in speaking or swallowing is the initial symptom in the bulbar form of the disease. Over a period of months or years, patients with ALS develop severe, progressive muscular weakness and other symptoms caused by loss of function in both upper and lower motor neurons.
Sphincter control, sensory function, intellectual abilities and skin integrity are preserved. Patients become completely disabled, often requiring ventilatory support and gastrostomy. Death usually occurs within five years of diagnosis and is attributed to respiratory failure or cachexia. The etiology of the disease is unknown. Current research is focused on abnormalities of neuronal cell metabolism involving glutamate and the role of potential neurotoxins and neurotrophic factors. New drugs are being developed based on these theories. Current management involves aggressive, individualized alleviation of symptoms and complications. Amyotrophic lateral sclerosis (ALS) was first described in 1.
Within 1. 5 months, she also described difficulty in writing, weakness of the right hand and arm, and diffuse muscle twitching with painful muscle cramps. Assessment confirmed weakness of all limbs, more marked on the right side, with muscle atrophy. Reflexes were hyperactive and fasciculations were observed in the right leg. Within two years, the patient became severely disabled because of generalized weakness. She experienced no sensory problems, intellectual deterioration or skin breakdown in spite of her degree of immobility. Difficulty in swallowing necessitated the use of a gastrostomy tube for feeding. The patient died of respiratory failure approximately three years after reporting the initial symptoms.
In the brain, atrophic changes may be found in the motor and pre- motor cortex.
The major lines of investigation include genetic, viral, autoimmune
Other hypothetic causes of ALS include neurotoxicity from various metals, chemicals or foods,
Those with upper limb onset may first notice difficulty in actions such as buttoning clothes, picking up small objects or turning keys. Speech problems, such as slurring, hoarseness or decreased volume, are the most common presentations in the bulbar form of ALS. As symptoms progressively worsen and spread, muscle atrophy becomes apparent and upper motor neuron symptoms such as spasticity complicate gait (in lower limb involvement) and manual dexterity (in upper limb involvement). Fasciculations in the affected limbs or the tongue cause âtwitching,â which may be embarrassing to the patient. Muscle pain may be caused by clonus or hyperreflexia. Many patients complain of muscle cramps. As the disease progresses, immobility from weakness and spasticity predisposes the patient to painful joint complications. Primary neuropathic pain does not occur in ALS. Patients with the bulbar form of ALS develop problems in swallowing that are worse for saliva and liquids than for solids. The combination of excessive salivation (sialorrhea) and difficulty in swallowing leads to drooling. Bulbar ALS also causes a variety of speech problems, such as dysarthria (articulation) and dysphonia (volume). These patients may also develop an exaggerated emotional response (âpseudobulbar affectâ) consisting of frequent, brief episodes of laughter or tears that alternate rapidly. Patients with ALS often experience fear, anxiety and depression. Weight loss is characteristic, and often the extent of cachexia cannot be explained by muscle atrophy or nutritional difficulties. The patients progress to a state of profound disability, and many eventually require ventilatory assistance and interventions such as gastrostomy for nutrition. Death is usually caused by respiratory failure. In spite of the widespread devastating effects of ALS, certain functions are conspicuously unaffected; extraocular muscle movement, bladder and bowel control, sensory function and skin integrity are usually preserved. The characteristic absence of pressure ulcers even in cachectic, bedridden patients may result from complex, poorly understood skin changes.
In one study, 8 percent of the patients were given an erroneous diagnosis of ALS, and one half of those patients had treatable conditions.
However, the unregulated format of the Internet may also include sites that provide unscientific information or promote unproven treatments. At least one other drug (mecasermin) is under consideration by the U. S. Food and Drug Administration. Clinical trials of other drugs are in progress. Riluzole is believed to decrease glutamate release. One large study
Any positive effect on functional abilities from the use of riluzole is unclear, and no studies have reported that the drug halts the disease process.
Drug. Bank: Fentanyl. Mark Rubino, âProcess of making fentanyl intermediates.â U. S. Patent US2. 00. May 1. 1, 2. 00. 6.
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