Approved treatments for amyotrophic lateral sclerosis (ALS) cannot reverse the damage caused by the disease or provide a cure, but they can slow the deterioration in function, prevent complications, and increase comfort and independence.

FDA-Approved ALS treatment

There are currently two drugs approved by the U.S. Food and Drug Administration (FDA) for the treatment of ALS. These are Rilutek (riluzole) and Radicava (edavarone).

Rilutek, approved by the FDA in 1995, is thought to interfere with the activity of glutamate, one of the chemical messengers that transmits signals between nerve cells. Glutamate can lead to toxicity when there is an excess in the central nervous system, as in the case with ALS.

Rilutek is taken by mouth and may cause adverse effects such as dizziness, gastrointestinal symptoms, and liver function changes.

Radicava, approved in 2017, is thought to counteract the excessive oxidative stress found in ALS. When taken over a six-month period, the drug has been shown to slow the rate of decline in ALS patients compared to placebo.

It is administered by infusion into a vein, typically for 10 to 14 days in a row, once a month. Side effects may include walking problems, bruising, and headache. Serious allergic reactions to sodium bisulfite within the formulation can also occur.

Symptomatic ALS treatments

Other drug therapies are targeted at some of the specific symptoms of ALS. For example, muscle relaxants such as baclofen or diazepam may be prescribed to treat muscle cramps, spasms, and spasticity, and gabapentin can help control pain.

Pooling of saliva in the mouth due to difficulty swallowing can also be treated with drugs such as Elavil (amitriptyline), trihexyphenidyl, Scopaderm (scopolamine patch), or the more potent Robinul (glycopyrrolate). These drugs all have in common their blockade of receptors for the signaling molecule acetylcholine, which reduces the production of saliva.

Medications may also be required for the treatment of constipation, fatigue, depression, difficulty sleeping, and uncontrolled outbursts of laughing or crying.

Non-drug therapies

In addition, non-drug therapies are an essential part of treatment for ALS. For example, easy to swallow foods are advised at early stages of the disease. As the condition progresses, however, a feeding tube may be required to reduce the risk of choking,

Physical therapy to tackle pain and mobility, specific exercises, and use of equipment such as braces or a wheelchair can help maintain muscle function and prolong independence.

Occupational therapists can also provide advice regarding adaptations in the home.

As the muscles involved in speech are affected, speech therapy can help to make ALS patients understood and explore other methods of communication including computerized voice synthesizers.

When breathing becomes more difficult, equipment may be required at night. In the later stages of the disease, a ventilator attached to a breathing tube inserted into the windpipe may be necessary.

ALS News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.