If speech gradually becomes slurred, swallowing food becomes difficult, and the limb muscles lose strength together, we can suspect amyotrophic lateral sclerosis, commonly known as ALS.
ALS is a progressive neurodegenerative disease in which motor neurons in the brain and spinal cord are gradually destroyed, causing muscular atrophy and loss of strength. It is a serious condition where nerve signals required to move the body fail to reach the muscles, leading to muscle wasting and eventually an inability to move. This situation brings tremendous suffering and burden not only to the patient but also to family members.
Initial symptoms of this disease vary widely among patients. For some, it starts as a bulbar-onset type where muscles around the tongue or throat weaken, leading to slurred speech (dysarthria), drooling, and difficulty swallowing food (dysphagia). For others, it manifests as a limb-onset type where strength in the arms or legs gradually drains and muscles stiffen or convulse. As the disease progresses, even the muscles responsible for breathing weaken, causing dyspnea. Because these symptoms progress slowly and gradually, they are often difficult to notice in the early stages.
Diagnosis is suspected through symptoms and a neurological examination, and nerve and muscle damage is confirmed through electromyography and a nerve conduction study. The process of excluding other disorders via brain MRI and other tests is also vital. Because early diagnosis is challenging and can be confused with other conditions, meticulous observation and examination by a specialist are essential. Receiving an accurate diagnosis from a neurologist is of utmost importance, so do not hesitate to visit a hospital if you have suspicious symptoms.
While the exact cause is not yet identified, it is presumed that genetic factors (5 to 10% of all patients have a family history), environmental factors, reactive oxygen species (free radicals), inflammation, and glutamate excitotoxicity interact in a complex manner. Various hypotheses, such as abnormal activation of microglia—the immune cells of the brain—and abnormal intracellular protein accumulation, are actively being researched. Countless researchers are working tirelessly day and night to uncover the causes and treatments for this disease.
Although there is no complete cure yet, there are treatments that slow the progression of the disease and alleviate symptoms. Typically, medications such as riluzole or edaravone are used. Alongside these, a multidisciplinary approach is crucial, including speech therapy to maintain speaking and swallowing abilities, physical therapy to slow muscular atrophy as much as possible, nutritional counseling with a dietitian, and respiratory management. Psychological support, along with the understanding and love of family members, is just as important as medical treatment.
While modern medicine has uncovered direct damage to nerve cells, it is notable that the Donguibogam viewed such symptoms as a wilting pattern resulting from the depletion of essence-qi or the decline of qi and blood. It understood the condition as a state where the balance of the body is broken and fundamental vitality is weakened. Although perspectives on the disease differ, efforts to slow disease progression and enhance quality of life have persisted throughout history. Consistent communication and management with medical staff are most critical, and maintaining a hopeful mindset will also provide tremendous strength.
