Multidisciplinary Care: a Hallmark of the ALS Center

Multidisciplinary Care: a Hallmark of the ALS Center

from Clinical Update, Fall 2004

Abstract: With new drugs on the horizon for treating ALS, early diagnosis is more important than ever. The ALS Center at Wake Forest Baptist offers patients a comprehensive team approach to evaluation and treatment planning, aimed at maximizing function and quality of life.

Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease) is one of the most devastating disorders that affects the function of nerves and muscles. Based on U.S. population studies, approximately 5,600 new cases are diagnosed each year, and as many as 30,000 Americans have the disease at any given time.

While there is no cure for ALS and it is progressive and fatal, recent advances in research and improved medical care allow many patients to live longer, more productive lives.

The latest research and treatment are offered at the ALS Center at Wake Forest University Baptist Medical Center, one of only 19 centers in the U.S., and the only one in the Southeast, certified by the National ALS Association.

A hallmark of the ALS Center, which opened in 1998, is its multidisciplinary care. “We offer team care by specialists in ALS,” said Peter Donofrio, M.D., professor of neurology and the Center’s director. This provides patients with a comprehensive evaluation and treatment plan aimed at maximizing function and quality of life.

The treatment team includes neurologists and specialists in nursing, clinical nutrition, physical, occupational and respiratory therapies, social work, clinical psychology, assistive technology and pastoral care. The comprehensive team approach enables patients to have all their health care needs met at one time, saving them the inconvenience of multiple visits.

The Center is currently following more than 150 patients from the Carolinas, Virginia, West Virginia and Tennessee.

The ALS Center at Wake Forest Baptist is involved in the quest for new ALS treatment and therapies. Through participation in clinical trials, ALS patients have access to the latest drug therapies. “Most experts believe ALS results from a multistep process rather than a single cause,” said James Caress, M.D., associate professor of neurology and an ALS specialist. “This theory allows for possible multiple avenues of therapy, such as a drug ‘cocktail’ approach that has been used effectively in cancer and AIDS.”

In basic research, the focus to date has been on glutamate toxicity in motor neurons, damage by free radicals and the effect of a mutation in the superoxide dismutase gene. This research has yielded the only clinically efficacious drug for ALS, riluzole (Rilutek^®), which is designed to diminish glutamate toxicity. Physicians and basic scientists at the ALS Center are also researching why motor neurons degenerate in ALS.

With new drugs on the horizon for treating ALS, early diagnosis is more important than ever. ALS presents in one of two ways: weakness in the extremities or problems with speech and swallowing. The disease most commonly affects people aged 40 to 70, with no racial, ethnic or socioeconomic boundaries.

Half of all people affected with ALS live at least three years after diagnosis. Twenty percent live five years or more and up to 10 percent will survive more than 10 years.