Collaborating across health care disciplines to combat ALS

In the nineties, amyotrophic lateral sclerosis (ALS) medical specialist Edward Kasarskis, MD, PhD, director of UK’s ALS Multidisciplinary Clinic, asked Tony English, PT, PhD, now the director of physical therapy at the College of Health Sciences, to participate in one of his new research studies. This partnership soon morphed into a clinic and later a collaboration to help find novel treatments for a rare type of the neurodegenerative disease in Kentucky patients.

“Dr. Kasarskis was involved in several drug trials over the years attempting to find a drug combination that will either stop the progression of ALS or reverse it altogether,” English said. “If he needed a physical therapist to participate in his research studies, he would call me.”

Kasarskis’ clinic moved to Cardinal Hill for a few years, but when the Kentucky Neuroscience Institute was established on the first floor of the Kentucky Clinic, the ALS clinic moved back to campus and the College of Health Sciences began providing physical, occupational and speech and language therapies.  There, several practitioners and therapists provide comprehensive evaluations of the patients, who come in every three to four months.

“Through physical and occupational therapy, we’re trying to help ALS patients maintain their highest level of function and quality of life,” English said. “We educate them on how to modify their day and activities so they can keep their energy levels up and continue doing what they want to do with their families.”

In addition to his teaching and practice, English is involved in two drug studies, one of which involves those who suffer from familial ALS. “There are different kinds of ALS,” he explained. “One is more idiopathic, where there’s no identified cause other than possibly an inflammatory process, and the other is this familial type. The genetic mutation in familial ALS is what causes the problem. About 10 percent of people diagnosed with ALS have the familial type.”

In the study involving familial ALS, the research team is attempting to discern whether or not a particular corticosteroid has a positive impact on function in people with ALS. “In Dr. Kasarskis’ years of medical practice, he’s seen enough people with this specific type of ALS. In this study, we administer a corticosteroid to see whether or not it slows the process of the disease down or if it helps patients maintain their functional ability. We’re also testing those who present with the genetic mutation but don’t present with ALS,” English said.

The second study in which English is involved is a multi-site study with five or six other ALS clinics across America. “We’re using a number of different data collections: muscle strength, gait speed, and others to determine how patients are performing physically while they’re taking a different medication. We’re looking for physical improvements that could signal a slower progression of the disease,” he explained.

There is still much to be discovered about ALS and the research done by English, Kasarskis, and the rest of the UK multidisciplinary team is incredibly crucial.

“Everybody who has ALS at this point in time passes away,” English said. “ALS slows the nervous system’s pathways to the muscles and weakens them. Ultimately, a patient’s diaphragm (muscle that helps us breathe) is affected. The typical length of life after diagnosis of the disease is about four years. What we are trying to do is find a medicine that will slow or even stop the progression of ALS so that patients can become more stable, function at  the highest level possible, and live longer.”