Complications
Respiratory failure is an inevitable consequence of ALS. Early symptoms can be effectively treated with non-invasive ventilation, while severe end-stage respiratory failure requires either tracheostomy, with permanent assisted ventilation, or palliative care.
Every effort should be made to ensure that ALS patients receive adequate nutrition throughout the course of their disease.
In patients with dysphagia and difficulty with airway maintenance, choking and aspiration pneumonia may develop at any time. The risk for aspiration pneumonia persists in patients on tube feeds; thus, precautions against aspiration should be maintained after feeding tube placement.
There is a risk of hepatotoxicity associated with the use of riluzole; however, with careful monitoring of liver function tests (LFTs), this adverse effect may be prevented. Drug should be discontinued if there is a persistent increase in LFTs, or with alanine aminotransferase exceeding 5 times the upper limits of normal.[128]
There is a rare risk of neutropenia associated with the use of riluzole. Close monitoring of FBC every month for the first 3 months and every 3 months thereafter is necessary during treatment. Drug must be discontinued if neutropenia is identified.[67]
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