Although a rare neurologic condition, Amyotrophic Lateral Sclerosis (ALS) is the most common type of Motor Neuron Disease (MND),  a condition that affects the voluntary muscles. This is a progressive disorder that leads to muscle weakness and depletion due to nerve dysfunction.

ALS is also called Lou Gehrig’s disease, named after the football player who had this condition. The literal meaning of Amyotrophic is ‘no muscle nourishment’ which becomes the cause of muscle atrophy. ‘Lateral’ refers to the group of nerves in the spinal cord that sends signals to the muscles. It is these nerves that degenerate, leading to sclerosis in this region. In later stages, this affects the nerves that control breathing and hence can be fatal.

The initial symptoms of ALS include stiffness and muscle weakness, which gradually involves all the muscles under voluntary control. The affected regions and progressive pattern vary from one person to another. Some having difficulty holding a pen or a cup while others finding difficulty speaking, chewing or even talking. Thus, ALS is an ailment that affects daily life and makes simple tasks painful and troublesome.

According to the Center for Disease Control and Prevention (CDC), 14,500 to 15,000 people had ALS in the United States in 2016,  with approximately 5000 people having a confirmed diagnosis for the condition annually. Although the average survival rate is three to five years, patients can live for ten years or more.

Are there different types of ALS?

Amyotrophic Lateral Sclerosis has two types:

Sporadic ALS: this is the most common one and affects 95% of sufferers. This type occurs without a clear cause.

Familial ALS (FALS): This type occurs in 5-10% of sufferers. This type of ALS is genetic and runs in families. This occurs due to abnormal changes to a gene that is then passed in generations

What are the symptoms of ALS?

Early signs and symptoms might be unnoticeable and become perceptible after some time. Most clinical signs are evident of upper motor neuron and lower motor neuron lesion. The limb onset ALS (70%) involves initial symptoms in the limbs while the bulbar onset ALS (25%) is characterized by speech and swallowing problems. This is followed by weakness in the limbs later. The remaining 5% of the patients have respiratory involvement in the early period. [5]

Most common symptoms include:

  • Muscle weakness in the limbs (distal or proximal)
  • Asymmetric progressive muscle wasting
  • Difficulty in motor activities like walking, talking, chewing
  • Weakness in arms, legs, hands, and feet
  • Muscle cramps and twitching
  • Slurred speech
  • Fatigue
  • Emotional liability (episodes of uncontrolled laughing and crying)
  • Difficulty in maintaining posture and gait
  • Difficulty in breathing and swallowing

With the progression of the disease, symptoms may spread to all parts of the body. In some patients, frontotemporal dementia may occur resulting in poor memory and decision-making abilities.

What Causes ALS?

The exact cause of ALS has not been known by scientists to date. However, research is being carried out to understand what causes ALS. There are several different factors such as: 

Genetic changes

Studies have shown that 5 to 10% of cases of ALS are caused by genetic mutations. For example, changes to the gene that makes SOD1 protein causes damage to motor neurons. 

Environmental factors

No major association has been established between environmental factors like toxins, viruses, diet or physical trauma and the risk of development of ALS. However, there is ongoing research on the subject. Studies have shown that some athletes are at a higher risk of acquiring ALS due to vigorous physical activity. 

Chemical disturbance

Glutamate is the neurotransmitter that is in control of signals to and from the brain. Accumulation of this neurotransmitter within the spaces surrounding the nerves damages them. 

Research has also shown mitochondrial structural and functional abnormalities, as well as defects in axonal structure and transport, could be the causative agents for ALS. 

How Do We Diagnosis ALS?

When it comes to diagnosis, there are no specific tests that can provide a definitive diagnosis for ALS. However, doctors conduct a series of tests to rule other similar diseases. A full medical history check and a neurologic examination are undertaken at regular intervals to assess the progressive worsening of symptoms. 

Running the following Image testing diagnostic tests can help reach a diagnosis:

  • Electromyography (EMG) – EMG records the electrical activity of the muscle fibers.
  • Nerve Conduction Study (NCS) – NCS assesses the electrical activity of the nerves and muscles.
  • Magnetic Resonance Imaging (MRI) – MRI rules out other possible conditions such as a tumor or cyst in the spinal cord, cervical spondylosis, or a hernia in the neck that could be causing the nerve compression.

Laboratory tests such as blood screening and urine tests can also be carried out so that other diseases can be eliminated. 

What Are The Treatment Options & Management Strategies For ALS?

ALS is managed through a multidisciplinary approach.

Unfortunately, there is no definitive cure for the disease at this time. Management of ALS is done through symptomatic treatment to ease the condition of the patients and prevent unnecessary complications:

Support – Physicians, psychologists, speech therapists, nutritionists, and home care assistance all play a vital role in making life easier for patients with ALS.

Medication – Riluzole (Rilutek) and Edaravone (Radicava) are the drugs approved by the U.S Food and Drug Administration (FDA) for treating ALS. Riluzole is believed to reduce glutamate levels thereby, decreasing damage to the motor neurons. Edaravone acts an antioxidant and is believed to expel free radicals and reduce the oxidative stress in the motor neurons.

Lifestyle Habits – Physiotherapists can recommend exercise and physical activity like walking, swimming, and bicycling that may improve muscle strength and help elevate mood without overstressing the muscles.

Speech Therapy – therapists can help patients with ALS to employ strategies to speak clearly. They may also recommend computerized aids such as speech synthesizers and eye-tracking technology to help people learn ways for responding by nonverbal means.

Diet – Nutritionists may formulate a diet plan for patients, which consists of food that is easy to swallow and provides enough nourishment and calories for the patients to maintain adequate energy levels and to prevent excessive weight loss

Breathing Support – Patients with ALS may suffer from shortness of breath and difficulty breathing during physical activity or while lying down. If this is the case, doctors can recommend Non-Invasive Ventilation (NIV) that provides breathing support through the nose or mouth. NIV improves quality of life and increases the number of years of survival for patients.

Is Stem Cell Therapy An Option?

As previously mentioned, there is no curable treatment for ALS available. However, scientists are researching Stem Cell Therapy as the new favorable approach in the treatment of neurologic disorders.

There is a rising interest in Stem Cell Therapy as a promising remedy for curing ALS. Mesenchymal stem cells are particularly believed to be the most suitable ones due to their availability, absence of ethical issues and positive results in various experiments.

Studies and clinical trials have begun to apprehend the benefits of MSC transplantation. They demonstrate that MSCs lead to a partial recovery of motor neurons and a delay in disease progression. Also, there has been no evidence of a major adverse effect after MSC transplantation. 

When testing this newfound research on animals, the lifespan of the subjected animal has increased with MSC transplantation. These positive results have encouraged the administration of MSC in ALS patients. 

However, despite the safe outcomes of MSC transplantation in humans, results show that there is only a partial improvement in ALS sufferers with only a few cases that showed a delay in disease progression. Hence, there is a need for further studies and trials on a higher number of human subjects for a better understanding of MSC effects so that more significant conclusions can be reached.

One of the treatments that the FDA approved for knee arthritis is a Hyalronic Acid (HA) injection, sometimes also known as  Viscosupplementation. It has been incredibly successful for knee arthritis. In fact, so successful that many physicians are starting to use it on other parts of the body, like the hip and shoulder, which the FDA does not approve of.

HA, when injected, works like the fluid that naturally surrounds your joints. This fluid can be like a lubricant for your joints, and absorb shock, allowing bones that otherwise cause arthritis pain cause much less. Over time, it is even absorbed into the joint, which can cause the body to create a more stable cartilage all on its own.

The evidence for this treatment is astounding, with a systematic review of 76 trials, all of which were randomized controller trials. The review noted that HA, when injected, can benefit function, reduce pain, and can be a reliable and effective treatment for knee osteoarthritis.

On the other hand, there is PRP therapy. Platelet Rich Plasma, or PRP, which is a type of blood that has 6 to 10 times more platelets than what is normally found in blood. They even contain many growth factors, such as Epidermal Growth Factor, Connective Tissue Growth Factor, and many more. These can help heal injured parts of the body by using the bodies natural healing tools.

However, PRP is not regulated by the FDA, and devices that are used to make PRP require said approval. Aside from this, multiple studies shoe that PRP can be very effective in the treatment of tendon injuries, as well as for osteoarthritis. This treatment can even help in the reduction of pain. There are even more studies being conducted on whether it can help other things, such as hair regrowth, cardiac muscle repair, and even dermatologic rejuvenation.

So should you use HA injections, or PRP?

In many studies, PRP has bee demonstrated to work just as well, if not better than HA. HA is also only FDA approved for the knee, meaning that it is not approved or covered for the use in any other joint. Also, the risk of infection and rejection is far less while using PRP, as it is a substance that comes from your own body, and contains white blood cells, which can help fight infection.

PRP also saves money in the long run, as using HA in a joint other than the knee is not FDA approved or covered by insurance. As a result, it can cost your patient 1500$ or more. This can even be on top of various other charges, such as doctors visits, and even the injection itself. PRP, on the other hand, only costs from 800 to 1200$ out of pocket.

So PRP has been demonstrated to be just as effective, if not better, than HA injections when it comes to arthritis pain. It does not pose a risk for infection or and auto-immune reaction either, and is even far cheaper than HA. So picking which one to use should be a no-brainer.

The entire field of orthopedics is looking for new regenerative technology that can save more patients more safely. Currently there are two contenders: Platelet-Rich Plasma and Stem Cell.

While PRP is the safest of the two, it’s really hard to dismiss the remarkable capabilities of stem cell therapy. In fact, I believe it’s the future of regenerative medicine. But not at the level it’s playing right now. Which is a totally different discussion we’ll save for another day.

The thing is… there are potential harm with stem cells. And unlike PRP, stem cell’s constituents are man-made, so things can go wrong. We’ll discuss the potential dark side of this therapy later in this article. However, I feel it’s important to highlight how good a treatment stem cell therapy is.

Quick Overview: Stem Cell Vs Platelet-Rich Plasma

Platelet-Rich Plasma is like water and nutrients that help restore (and sometimes accelerate) your body’s EXISTING healing mechanism. If your body is stuck with its healing, PRP can help. It releases growth factors and cytokines to kick start the healing. Stem cells on the other hand is not used to enhance healing, but to create new solutions to healing challenges. So it’s more for tissues that are totally lost.

Stem Cell Vs Platelet-Rich Plasma

With me? Before we proceed, let’s look at a little background of stem cells. We’ll stick to orthopedics for the sake of simplicity.

Orthopedic Stem Cell Therapy

Stem cells are naturally found in the human body and they are a fundamental part of the body’s normal healing process. Stem cells are known as ‘raw potential’ as they can be converted into any cell that the body needs. The body utilizes stem cells to substitute damaged and/or injured cells. This process allows natural healing and repair of the injured or damaged cells.

As the body gets older the amount of natural reserved stem cells starts to decline, which explains why the healing process is slower as the body gets older. Stem cell therapy resolves this shortage by injecting supplementary stem cells into the injured/damaged area of the body, which triggers the cell replacement, natural healing, and pain relief.

Stem cell therapy is a simple and quick procedure, taking about 15 minutes. Pain discomfort is often felt immediately, with the majority people reporting a significant improvement within one to two days.

With stem cell therapy the patient does not have to have any type of surgical procedure, local or general or downtime. Most of the patients experience a complete restoration of the damaged/ injured ligaments, tendons, and cartilage within about in 28 days. Stem cell therapy has been proven to be complexly safe, with no side effects reported in the US or in Europe.

The Difference Between Stem Cell Therapy and Platelet-Rich Plasma (PRP) Therapy

Often times, stem cell therapy and PRP can be confused because they have a lot in common during the healing process. The easiest way to tell the difference between the two, is PRP is removed from the patient’s own body, it goes through a scientific process and is them injected into the area being treated.

The cells used for stem cell therapy can come from a few different places; from an unviable embryo, and unviable fetal stem cells these stem cells are the most often used because the cells are unspecialized and can be made into specialized cells. As it sounds, preparing stem cells for therapy is a complex process. Stem cells are produced in a sophisticated labs by cell biologists and are typically grown over several weeks before it’s ready.

Plus, adult stem cells may be used, although it is not nearly as common yet because scientists are still working on ways to identify stem cells within the tissue of an adult human body.

Stem Cell Vs Platelet-Rich Plasma

So what’s the dark side of Stem Cell Therapy?

The obvious concern is that treatments with stem cells could be dangerous if not carefully controlled. I know we are all doing things for saving lives and helping people live longer, more happily, but the risks must also be considered.

Below are the 5 risks that stem cells carry. (which Platelet-Rich Plasma doesn’t.)

Risk of viruses: Since the stem cells are foreign bodies, if they happen to carry harmful microscopic agents, it’ll bring unnecessary complications. Especially those patients whose immune systems are weak, could be highly vulnerable diseases.

Uncontrolled growth: As I said before, stem cells are produced in a lab and grown over a period of several weeks. However, there is very tiny possibility the growth will continue uncontrolled after installing it into the patient. We pray it doesn’t happen.

Multi-tasking of cells: Stem cells are cultivated and grown into specialized cells that are designed to be doing just one thing and one thing only. But what if, in the long run, they also do other things that wasn’t in the original scope of things? Something to ponder.

That said, I still believe stem cells hold great promise. Now, I want to take this rest of the article to highlight a few of the common conditions that are found to be best for stem cell treatments.

Stem Cell Vs Platelet-Rich Plasma

Rheumatoid Arthritis

Rheumatoid Arthritis is caused by inflammation of the joints as a result of an autoimmune progression. The body’s immune system attacks the joints. Patients with Rheumatoid Arthritis suffer from mild to severe pain, constant fatigue, warm, and swollen joints. This type of chronic inflammation has the potential to easily damage the joints. Therefore, treatment is concentrated on decreasing the inflammation and slowing down the progress of the condition. Stem cell therapy provides a treatment alternative that takes advantage of the healing and anti-inflammatory effects.

Osteoarthritis

Osteoarthritis is joint inflammation caused by the deterioration of the cartilage that cause the bones to rub up against one another. Patients who suffer from osteoarthritis have pain, stiffness, and a decrease in their range of motion in their joints. Although, there is no cure for osteoarthritis, stem cell treatment focuses on reducing the pain reduction through medication, physical therapy, or occupational therapy. Stem cell therapy provides a treatment alternative that takes advantage of the healing and anti-inflammatory effects. While medication helps with the pain.

Shoulder Repair

Shoulder injuries such as rotator cuff tears and arthritis of the shoulder joint, as well as other types shoulder pain may be responsive to stem cell therapy. Stem cells goal is to renew damaged joints.

Stem Cell Treatment for Joint Repair

Hand and elbow problems caused by arthritis of the joints is a type of deteriorating joint disease that has disabled millions of people. Definite types of wrist and elbow joint issues including certain ligamentous injuries and tendon problems may not benefit from cell therapy. It is very important that the doctor evaluate each patient to see if stem cell therapy is a viable treatment for their patients.

Stem Cell Treatment for Knee

Knee arthritis is a type of deteriorating joint disease, which affects millions of people. Most people believe there only option for pain relief and better mobility is steroid injections or surgery, including total knee replacement surgery. However, that is not the case, many people benefit greatly from stem cell therapy. Specific types of knee issues such as, ligamentous injuries and substantial meniscal injuries may not be responsive to regenerative therapy (stem cell therapy). Each case must be carefully evaluated and the orthopedist will decide what options are best for the patient, in some cases, stem cell therapy is tried even if the patient is not exactly an ideal candidate, but trying is better than just scheduling surgery.

Stem Cell Treatment for Hip

Hip arthritis is similar to knee arthritis; millions of people suffer from hip problems. Patients usually try to delay the hip replacement surgery as long as they can and try other methods such as steroid injections, which for some people do help for a short period of time. However, long tern injects can damage the tissue near the hip. While fractured hips and certain kinds of hip injuries cannot be treated with stem cell therapy, surgery is the only available option left.

Stem Cell Treatment for Joint Repair

Problems with the hands and elbow joints usually respond well to stem cell therapy. If there are problems with the ligaments and tendons, then surgery may be necessary.

Degenerative joint diseases disable millions of people. While certain types of injuries are not a good match for stem cell therapy, there are several that are a good match. Before you prescribe surgery to repair damaged or injured joints consider about stem cell therapy, and if possible give it a try first.