Amyotrophic Lateral Sclerosis and Cardiac Function: How can we do with Hummingbird’s Racing Hearts?

Amyotrophic lateral sclerosis (ALS) is a degenerative disease that classically affects the motor neuron, causing paralysis, flaccidity and death. However, although its etiopathogenesis is not fully elucidated, it is known that its involvement is not only motor, but also has a strong interaction with the autonomic nervous system, with cardiovascular, gastrointestinal and sleep effects, for example. The disease, which leads to death mainly from respiratory complications, also has underestimated cardiovascular effects, like increased heart rate variability, malignant arrhythmias and sudden death. These aspects raise several questions, such as whether there is a direct correlation between autonomic effects and the underlying disease, whether the onset of autonomic symptoms occurs at an early or late stage of the disease and whether there is an effective therapy to modulate these alterations. A valid question is whether the use of beta-blockers would be effective in modulating symptoms related to increased heart rate and in preventing sudden death and malignant arrhythmias found in some of these patients. It is also important to highlight the role of motor and respiratory physiotherapy in controlling complications of the respiratory system and in improving the quality of sleep of patients with ALS. With this, it is important that we see that amyotrophic lateral sclerosis is not an exclusive motor neuron disease, but has other mechanisms that have not yet been fully clarified, including autonomic changes. Thus, we must direct therapies and studies to these changes, which have a direct impact on the patient’s morbidity, mortality and quality of life.

Keywords:Amyotrophic lateral sclerosis; Autonomic nervous system; Autonomic modulation