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 feel soreness and pain in their legs when lying down?

People with ALS often experience soreness and pain in their legs when lying down. In patients with ALS, certain neurons in the brain and spinal cord gradually degenerate and die, leading to muscle atrophy, nerve damage, muscle weakness, and stiffness, as if they are frozen. This muscle damage can lead to symptoms such as sore legs, general weakness, and fatigue. Over time, it may also cause difficulties in walking, speaking, eating, choking while drinking water, swallowing, and breathing. This can lead to systemic damage, complications like breathing difficulties, respiratory failure, and ultimately threaten life. The symptoms of leg pain and soreness in people with ALS, when lying down, can be alleviated through acupuncture, physical therapy, massage, and heat application.

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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 Liu Shi Xiang
Neurology
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Does amyotrophic lateral sclerosis cause leg soreness?

Patients with amyotrophic lateral sclerosis (ALS) may experience leg pain, but leg pain is not the primary clinical manifestation of ALS. The early main symptoms of ALS include muscle atrophy and limb weakness. As the disease progresses, patients will further experience general muscle atrophy and weakness, which may manifest as difficulty in swallowing, speech problems, and respiratory difficulties. As the disease progresses, if the patient experiences extreme muscle atrophy and limb weakness, they may experience leg pain during movement, but this symptom is not specific. Therefore, when symptoms such as muscle atrophy and limb weakness occur, the possibility of ALS should be considered, and patients need to undergo timely examinations such as electromyography and muscle biopsy to confirm the diagnosis. If the patient also suffers from leg pain, other conditions such as sciatica and osteoporosis should be considered, and further examinations like bone density tests and lumbar disc magnetic resonance imaging should be conducted to clarify the diagnosis.

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Written by Liu Hong Mei
Neurology
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Is it normal for someone with ALS to have severe swelling in their feet?

ALS patients with severe foot swelling is not normal. If an ALS patient experiences severe swelling of the feet, it is important to be cautious of the formation of blood clots in the lower limb vessels. The formation of venous blood clots can lead to poor blood circulation, easily causing blood stasis and thrombotic obstruction, leading to severe swelling of the feet. It is necessary to conduct a Doppler ultrasound of the lower limb vessels to assess their condition. Treatments may include anti-platelet aggregation, anticoagulation, promoting blood circulation to remove blood stasis, and providing nutritional support to nerves. Heat application, keeping warm, promoting lower limb blood circulation, acupuncture, physical therapy, massage, and heat application can be used as symptomatic treatments. For ALS patients with severe foot swelling, it is advisable to elevate the lower limbs during sleep, perhaps covering them with a blanket or elevating them about 45 degrees.

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Written by Liu Hong Mei
Neurology
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What should people with ALS do if they cannot eat?

People with amyotrophic lateral sclerosis who are unable to eat may try liquid and semi-liquid diets, using warm liquids, eating little by little. If they cannot consume a liquid diet, they may need to resort to nasogastric feeding. A gastric tube is used for feeding, through which high-nutrition, high-protein, and high-calorie diets can be provided to sustain and extend the life of those with the condition. Avoid overeating and engage in appropriate exercise, paying attention to the functions of the respiratory and digestive systems. If there is excessive saliva, a small amount of antihistamine medication can be administered. If there is an excess of phlegm, nebulized inhalation and expectorant medications might be provided. If feeding through a gastric tube is also limited, intravenous nutritional support can be given.