What to do with respiratory failure in the late stage of amyotrophic lateral sclerosis?

Written by Li Qiang
Intensive Care Unit
Updated on September 10, 2024
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Amyotrophic Lateral Sclerosis (ALS) is an irreversible disease, also known as motor neuron disease. Its motor function deteriorates progressively and irreversibly. Therefore, in the advanced stages, respiratory failure can only be managed with the help of a ventilator, which assists the patient's breathing mechanically. Consequently, patients typically require a tracheotomy in the late stages of the disease. Once connected to a ventilator via a tracheotomy, the ventilator becomes a permanent necessity. If at any point the ventilator is stopped, the patient would die due to lack of oxygen and the accumulation of carbon dioxide in the body. Therefore, they must wear the ventilator for life. Inevitably, this leads to respiratory-related complications, such as lung infections.

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Written by Liu Hong Mei
Neurology
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Do people with ALS experience frequent muscle twitching?

Muscle twitching in people with ALS (Amyotrophic Lateral Sclerosis) can be very frequent. When muscles in ALS patients experience spasms, irritation, weakness, or fatigue, twitching is likely to occur. Muscle twitching in ALS patients is generally very frequent and is related to the disease. ALS, often referred to as motor neuron disease, is caused by degenerative changes in the central nervous system, such as the spinal cord and brain, leading to damage in the neuromuscular system, resulting in muscle atrophy, twitching, and tremors. It is advisable to seek medical evaluation and, once diagnosed, pursue active treatment which may include nutritional support, massage acupuncture, and functional exercise.

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Written by Li Qiang
Intensive Care Unit
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Is it necessary to perform a tracheotomy in the late stages of ALS?

Patients in the late stages of amyotrophic lateral sclerosis (ALS) must undergo a tracheotomy because, by this stage, they have completely lost their motor abilities, including the muscle strength needed for breathing. Consequently, they lack the strength to breathe on their own, leaving them unable to survive without a ventilator. They must rely continuously on a ventilator to breathe as they cannot do it themselves. Therefore, if a ventilator is needed over the long term, a tracheotomy is necessary. This is because other methods, such as inserting tubes through the mouth or nose into the trachea to connect to the ventilator, are quite uncomfortable. Comparatively, tracheotomy offers a bit more comfort, making it a necessary procedure for connecting to a ventilator for long-term use and achieving greater comfort.

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Written by Zhang Hui
Neurology
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Can amyotrophic lateral sclerosis be relieved?

Amyotrophic lateral sclerosis (ALS) refers to a motor neuron disease, and generally speaking, there are no effective alleviation measures for this disease. Currently, the specific causes and pathogenesis of this disease are not very clear. Various factors lead to the simultaneous damage of both upper and lower motor neurons in patients. Clinical manifestations include muscle weakness, muscle atrophy, and fasciculations. Additionally, patients may experience difficulties with swallowing, choking while drinking water, and speech disorders. In its most severe form, it can affect breathing, leading to respiratory failure. This disease progressively worsens, and the prognosis is generally poor with no effective relief methods available.

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Written by Zhang Hui
Neurology
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Does amyotrophic lateral sclerosis cause numbness in the hands?

Amyotrophic lateral sclerosis (ALS) refers to a motor neuron disease. Patients with this disease generally do not experience numbness in the hands, mainly because it primarily affects the motor system and does not impact the sensory system. Thus, the vast majority of patients will not have sensory disturbances or experience clinical manifestations of numbness in the hands. The specific causes and mechanisms of this disease are still not very clear, but they may be related to genetic factors, the toxic effects of excitatory amino acids, oxidative stress, and mitochondrial dysfunction. Symptoms in patients gradually worsen, and respiratory function impairment may also occur. However, so far, there is no effective cure.

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Written by Liu Hong Mei
Neurology
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How to exercise for swallowing difficulties in people with amyotrophic lateral sclerosis

Swallowing difficulties in amyotrophic lateral sclerosis primarily involve exercises for oral muscles. Improvement in the movement of oral muscles can alleviate symptoms of swallowing difficulties. Rehabilitation training for oral muscle disorders mainly includes enhancing the movements of the lips, tongue, and lower jaw. Individuals with amyotrophic lateral sclerosis who have brainstem damage and medullary damage may experience swallowing difficulties, water drinking issues, and cough choking, primarily due to sensory disturbances in the throat. By utilizing temperature and sensory stimulation, the sensation in the patient's throat can be restored, allowing them to perceive the temperature and taste of food, thus reducing aspiration. After brainstem damage, the cricopharyngeal muscle does not open, which can be improved through balloon dilation and medication to enhance swallowing function.