About ALS

Just what is ALS? Amyotrophic Lateral Sclerosis (ALS) is a motor neuron disease, first described in 1869 by the noted French neurologist Jean-Martin Charcot. Although the cause of ALS is not completely understood, the last decade has brought a wealth of new scientific understanding about the disease that provides hope for the future.

Lou Gehrig first brought national and international attention to the disease in 1939 when he abruptly retired from baseball after being diagnosed with ALS. Most commonly, the disease strikes people between the ages of 40 and 70, and as many as 30,000 Americans have the disease at any given time. ALS has cut short the lives of other such notable and courageous individuals as Hall of Fame pitcher Jim "Catfish" Hunter, Senator Jacob Javits, actors Michael Zaslow and David Niven, creator of Sesame Street Jon Stone, boxing champion Ezzard Charles, NBA Hall of Fame basketball player George Yardley, pro football player Glenn Montgomery, golfer Jeff Julian, golf caddie Bruce Edwards, musician Lead Belly (Huddie Ledbetter), photographer Eddie Adams, entertainer Dennis Day, jazz musician Charles Mingus, composer Dimitri Shostakovich, former vice president of the United States Henry A. Wallace and U.S. Army General Maxwell Taylor.

ALS is a neurodegenerative disease that usually attacks both upper and lower motor neurons and causes degeneration throughout the brain and spinal cord. A common first symptom is a painless weakness in a hand, foot, arm or leg, which occurs in more than half of all cases. Other early symptoms include speech swallowing or walking difficulty.

The biological mechanisms that cause ALS are only partially understood. The only known cause of ALS is a mutation of a specific gene: the SOD1 gene. This mutation is believed to make a defective protein that is toxic to motor nerve cells. The SOD1 mutation, however, accounts for only 1 or 2 percent of ALS cases, or 20 percent of the familial (inherited) cases.

Familial ALS represents between five to 10 percent of all cases. The rest arise spontaneously and mysteriously, making seemingly random attacks on previously healthy adults. ALS can strike anyone, anytime.

Physicians have limited choices for treating ALS, and the options that do exist have come into use within the last 10 years. Studies suggest that patients' length of survival and quality of life are enhanced by night-time breathing assistance early in the course of the disease and by aggressive application of alternate feeding options to assure good nutrition once swallowing becomes difficult. At this time, Riluzole® is the only drug that has been approved by the FDA for treatment of ALS. In clinical trials, Riluzole® has shown a slight benefit in modestly increasing survival time.

Stem cell and gene therapy are promising areas of research. In a variety of studies, ALS mouse models are being used to develop treatments that may someday lead to similar human clinical trials. Gene therapy is one field of research where The ALS Association is concentrating support for more study.

More significant advances of research into ALS has occurred in the last decade than all of the time since Charcot identified the disease. Advances in technology and the genetic revolution are aiding researchers in unlocking the ALS mystery. As more scientists focus on this perplexing disease, the outlook for new understanding brightens each day.

Perspective from Hiroshi Mitsumoto, M.D., Cleveland Clinic
ALSA Center and Chair of ALSA's Medical Advisory
Committee: "In a review of ALS published in the
Archives of Neurology in 1988, I quote Lewis Thomas.
'The whole field of biomedical science is on the
move as never before in the long history of medicine.
I don't know what will happen over the next 20 years,
but my guess is that we are on the verge of discoveries
that will match the best achievement in infectious disease
a generation ago.' In ten years - just half of Lewis' prediction
- we now know the gene responsible for some familial ALS;
we have the first drug we can prescribe for ALS; we have
a real animal model for this disease and we have incredibly
important knowledge on the cell death mechanisms of
motor neurons in ALS. Yes, the progress still appears
to be too slow for anyone waiting for a breakthrough, but
we are truly on the verge of more exciting discoveries.
We have solid reasons for strong hope in ALS." There is
no question about whether the cause of ALS will be found;
it is only a question of when.