ALS (Amyotrophic Lateral Sclerosis, Lou Gehrig’s disease)
ALS is a progressive, adult-onset disease causing the loss of muscle mass, strength and function, with associated stiffening. It is difficult to diagnose in its earliest stages. Its onset can be barely perceptible, often occurring in one part of the body and progressing there, then spreading to adjacent areas, ultimately affecting all the muscles of the body. It leads to paralysis of limb muscles, and to muscles involved in speech, swallowing and breathing, ultimately causing the patient to succumb.
ALS is difficult to experience both for the patients and for their families. Rapid diagnosis shortens the time spent searching for a diagnosis, which lasts on the average 12 months from disease onset. It may permit early planning for the future, and prioritization of how to spend the present, when the effects of the disease are minimal or mild.
Patients often seek a second opinion after they have been diagnosed with ALS. The process permits meticulous review of all the alternatives, and provides additional opportunity to discuss the disease and its evolution after the initial shock of receiving the diagnosis has subsided somewhat.
Dr. Armon has specialized in understanding the disease ALS and treating patients since 1988. He established two multidisciplinary clinics for the diagnosis and treatment of this disease when he worked in the United States, and since his return to Israel had focused on diagnosing the disease, particularly in its atypical presentations.
Dr. Armon is the author of numerous publications regarding risk factors for ALS, and was one of the first to identify the mechanisms likely underlying the transition from a healthy individual to having ALS. Dr. Armon has subspecialty certification in Neuromuscular Medicine from the American Board of Psychiatry and Neurology.
In your consultation with Dr. Armon you will be asked to describe how your difficulties evolved. Dr. Armon will review the tests you have had and will perform a neurological exam. At the end of the consultation Dr. Armon will provide his opinion regarding your diagnosis and answer your questions. If he possibility that you may have ALS comes up for the first time at your first visit with Dr. Armon, he will likely request additional tests to exclude alternative diagnoses and schedule a follow-up appointment to discuss the results and their significance. It is important to come with family members to appointments where a difficult diagnosis may be discussed, in order to give them the opportunity to ask questions and have them answered.
1. Wikipedia article by Camel Armon: amyotrophic lateral sclerosis (ALS) – differential diagnosis
2. Amyotrophic Lateral Sclerosis-Practice Essentials – Carmel Armon
3. Smoking is a cause of amyotrophic lateral sclerosis. High low-density lipoprotein cholesterol levels? Unsure. Armon C. Ann Neurol. 2019; 85:465-469.
Armon C. J Neurol Sci. 2018; 391:134-140.
Armon C. Muscle Nerve. 2016;53:842-849
Armon C. Neurology. 2009;73:1693-1698.
Armon C. Neuroepidemiology. 2003;22:217-228
Frequently Asked Questions
ALS is a progressive, adult-onset disease causing the loss of muscle mass, strength and function, with associated stiffening. It is caused by the systematic, gradual loss of nerve cells in the motor neuron super-network located in the brain and in the spinal cord. The disease usually begins in one place, often imperceptibly, then progress locally and spread to other parts of the body.
The rate of progression of the disease, and the mix of symptoms that develop vary from one individual to another, depending on where it started and which nerve cells it involves.
It is harder to diagnose ALS in its early stages.
Early diagnosis shortens the time spent searching for a diagnosis, which lasts on the average 12 months from disease onset. It may permit early planning for the future, and prioritization of how to spend the present, when the effects of the disease are minimal or mild.
There are pharmacological treatments for ALS, but their effectiveness is limited. They have not resulted in reported extension of patient longevity when examined at the population level.
Half patients with ALS do not experience personality, cognitive or behavioral changes as part of their disease, but the other half does experience such changes, which range from the mild to the severe.
Often, people who have been diagnosed with ALS wish to receive a second opinion regarding their diagnosis. The process of obtaining a second opinion is an opportunity to verify that a credible alternative has not been overlooked and gives patients and families the opportunity to have their questions about the disease answered.
Dr. Armon can share his experience in the evaluation and care of patients with ALS to help patients and families understand the condition, anticipate its course, and prepare to manage its complications.