Differences Between Multiple Sclerosis and Amyotrophic Lateral Sclerosis and the Impact of the 2024 ALS Law

In this article, we look at the main differences between multiple sclerosis and amyotrophic lateral sclerosis, and we explore how Spain’s ALS Law affects treatment and rehabilitation services for patients with ALS.

Neurodegenerative diseases such as multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) seriously affect the quality of life of the people who have them. Although both conditions affect the nervous system, they differ significantly in their causes, symptoms, and treatments. With the recent approval of the 2024 ALS Law in Spain, new opportunities are opening up to improve care and rehabilitation for people with ALS, with a major impact on the field of neurorehabilitation.

MS and ALS: same first name, different last name

There is a lot of confusion between multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS). Many people think they are the same disease, but they are actually very different, even though both are neurodegenerative diseases and both are called “sclerosis.” That’s why we wanted to explain the main differences between MS and ALS.

What causes them?

Multiple sclerosis is an autoimmune disease caused by an unknown virus or antigen. In this case, the body’s immune system attacks myelin, a substance that surrounds nerve fibers and allows nerve impulses to travel at the right speed. As a result, communication between neurons breaks down, causing a variety of symptoms that we describe below.

In amyotrophic lateral sclerosis, the nerve cells responsible for voluntary movement in both the brain and the spinal cord are affected. That’s why this disease affects only the motor system. Its cause is also unknown.

Symptoms of MS and ALS

The most common symptoms of multiple sclerosis are visual disturbances, balance problems, speech problems, hand tremors, limb weakness, and loss of strength. Cognitive problems with memory and with encoding and retrieving information are also common, as are emotional problems such as anxiety and depression.

On the other hand, as mentioned above, a patient with amyotrophic lateral sclerosis only has motor symptoms. Their voluntary movements are affected, and they experience loss of strength in their arms and legs, problems articulating words, and difficulty swallowing. It’s important to stress how serious this disease is, since the patient may eventually develop respiratory muscle dysfunction, which is why life expectancy is 3 to 5 years from diagnosis.

How are they diagnosed?

Multiple sclerosis is neither contagious nor hereditary, and it can’t be prevented. Early diagnosis is essential.

MS is diagnosed through:

• Clinical history.
• Neurological examination.
• Evoked potentials.
• Cerebrospinal fluid analysis.
• Demyelinating lesions that can be identified through magnetic resonance imaging. Magnetic resonance imaging (MRI) is one of the main tests for diagnosing multiple sclerosis. It’s a noninvasive technique that captures very detailed images of the brain and spinal cord.

An MRI shows the brain lesions caused by the immune system’s attack on myelin. However, it’s important to note that this test can’t be considered conclusive, since not all lesions can be picked up by the scanner and other diseases can produce identical abnormalities.

Amyotrophic lateral sclerosis is difficult to diagnose because its symptoms are similar to those of other diseases. Diagnosis is based on the symptoms detected and on a test called electromyography. In some cases, more tests are needed if doubts remain, such as cervical or brain MRIs, muscle biopsies, blood tests, or a lumbar puncture.

Treatment

There is currently no cure for either of these neurodegenerative diseases. However, some medications can slow their progression and improve symptoms.

In both cases, treatment consists of medications that slow the progression of the disease, combined with physical therapy, occupational therapy, and speech therapy sessions. In multiple sclerosis, the neuropsychologist also plays a key role in addressing the cognitive deficits that appear over time.

How do MS and ALS progress?

In multiple sclerosis, 85% of patients have a course characterized by periodic relapses and remissions (relapsing-remitting multiple sclerosis). These relapses cause symptoms that last 24–72 hours and then subside. They often disappear completely, but this doesn’t prevent patients from gradually deteriorating with each attack. The other 15% of patients have a slower, progressive onset (primary progressive form).

Amyotrophic lateral sclerosis, in contrast, is always progressive, although the rate of decline can vary from patient to patient.

Who is affected by multiple sclerosis and amyotrophic lateral sclerosis?

MS mainly affects young women between 20 and 40, while the primary progressive form mainly affects men between 50 and 60.

ALS, on the other hand, affects people between 40 and 70, with a ratio of 3 men for every woman.

The 2024 ALS Law

On October 10, 2024, the ALS Law was approved in Spain. This legislation aims to improve the living conditions of people with amyotrophic lateral sclerosis (ALS) and strengthen their right to access treatment and care.

This law represents a major step forward in many ways. It isn’t just progress in public policy; it will also have a positive impact on healthcare and neurorehabilitation professionals, who will now have more resources to provide comprehensive, multidisciplinary treatment to their patients.

Main benefits of the 2024 ALS Law for people with ALS

Access to advanced treatments

The new law makes it easier for people with ALS to access advanced, innovative, and experimental treatments that were previously out of reach. These include both approved therapies and experimental treatments that could make a difference in the course of the disease.

• Availability of experimental treatments: patients can access medications and therapies in clinical trials that could improve their quality of life or slow the progression of the disease.
• Equal access to new therapies: it ensures that everyone, regardless of their financial situation or where they live, has the same opportunity to benefit from advanced ALS treatments.

Financial support

Since the financial burden on people with ALS can be overwhelming, the law includes financial aid aimed at improving the quality of life of those with the disease and reducing the financial impact on their families.

• Medication subsidies: patients can receive the latest medications with greater public coverage, easing the financial burden on families.
• Tax benefits: tax incentives are offered to families of people with ALS to reduce the costs of treatment and daily care.
• Long-term support funds: the ALS Law also creates a specific fund to ensure the financial sustainability of people with the disease and their families. This includes specific government aid they can use for wheelchairs and other mobility devices, as well as to adapt their homes to their particular needs.

Improved home care

Home care also improves with the approval of the 2024 ALS Law. From now on, patients have access to specialized home care in managing neurodegenerative diseases. This includes 24-hour continuous care from professionals such as physical therapists, occupational therapists, speech-language pathologists, and neuropsychologists.

Promoting research

The Carlos III Health Institute is setting up a structure focused exclusively on ALS research to promote research, development, innovation, and outreach on this condition and to drive scientific progress related to it.

The ALS Law also offers incentives to scientific institutions to promote research on amyotrophic lateral sclerosis (ALS), which could speed up the development of more effective treatments and improve patients’ living conditions.

National Registry of Neurodegenerative Diseases

The ALS Law establishes the National Registry of Neurodegenerative Diseases to collect valuable information on the incidence, prevalence, and other aspects of this neurodegenerative disease.

Collecting and accessing these data will, in the future, help us better understand the impact of ALS and optimize the management of care resources for people with the disease.

Conclusion

Although multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) are neurodegenerative diseases with significant differences in their progression and treatment, the recent approval of the 2024 ALS Law is a crucial change for people with ALS.

This law offers better access to advanced treatments, specialized home care, and financial support for patients and their families. It also promotes research on amyotrophic lateral sclerosis and ensures more comprehensive care.

The 2024 ALS Law marks a turning point in the fight against ALS, bringing hope and improving the quality of life of those affected.

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“This article has been translated. Link to the original article in Spanish:”
Diferencias entre la esclerosis múltiple y la esclerosis lateral amiotrófica y el impacto de la Ley ELA 2024