Using Sugammadex in ALS Patients

[jean-pierre-le-rouzic]

Thanks Richard,

A few years ago there were a lot of talk about anesthesia in another forum. One forum member observed that his wife seemed to be in better shape after anesthesia. Their focus was on an anesthesia inducing drug (propofol), not on reversing the neuromuscular blockade after anesthesia (sugammadex), so maybe they missed something interesting.
From a 20,000 miles ALS perspective it sure makes more sense to look at a drug unblocking the neuromuscular junction, that at one inducing it.
This would appear to favor the “dying backward” ALS etiology hypothesis, yet the mainstream hypothesis is the “dying forward” hypothesis where the disease starts in brain’s motor area. While there are good evidence for both hypotheses I find it strange that the focal start and  propagation there is in ALS, could be well explained with the “dying forward” hypothesis. But everything is so bizarre in ALS!

[nancy-gilkeson]

Whoops…

My question just now should have been directed to Jean-Pierre…., Pardon.

 

[nancy-gilkeson]

Hi Rich (my brother’s shortened name as well!),

Could you lead me to info re: the meaning of “dying forward” & “dying backward” ?  I’m new to those words… frankly this whole subject matter.  Thanks,

Nancy

[jean-pierre-le-rouzic]

Hi Nancy,

Scientists have made two very broad hypotheses about the location where the ALS starts. To explain it simply: One supposes ALS starts in the motor area in the brain (“dying forward”) and the other tells it starts at the junction between a muscle and the nerves that act on this muscle.
Both hypotheses provide good evidence, there is a problem however as there are several feet between the two locations so one of these hypotheses should be wrong.
The “dying forward” hypothesis is the current mainstream opinion, but it is so only since a few decades. From the publications I infer that roughly 3 out of 4 scientists agree with this hypothesis. A good reference article by the founder of this hypothesis was published recently.

We can see the same kind of debate in Alzheimer and Parkinson diseases. One of my favorite scientists is Heiko Braak. He tells that Parkinson starts in the guts. Other scientists say the same for Alzheimer.

My personal take on this is that the problem is ill defined, we still rely on century ideas old concepts. It was only recently that scientists understood that neurons are not the only kind of cells when new microscopes and imaging techniques revealed new information. Now we begin to understand that cells do not live in isolation, they compete, cooperate and negotiate at the same time. it’s a very fluid situation and today’s conceptual tools in biology are too simplistic to deal with the complexity of biology.
Probably both hypotheses are true … and false!

(A caveat: I am not a scientist)

[richardhasals]

From my google searches, the latest information on Sugammadex is about 1 year old.  Hoping to see more research and information on Sugammadex and its relationship to being a possible ALS treatment.

 

Rich

 

[richardhasals]

Hi Nancy,  Perhaps this link could further explain the meaning of “dying forward” & “dying backward”:

https://www.researchgate.net/figure/The-dying-forward-and-dying-back-hypothesis-of-amyotrophic-lateral-sclerosis-ALS-The_fig4_233977721

 

Rich

 

 

[Dagmar]

Richard – – that was a helpful visual.

[nancy-gilkeson]

Thank you both, Rich and Jean-Pierre for your answers & links.

Nancy