# Treatment approaches for ALS
The treatment of ALS aims to slow the disease for as long as possible, relieve symptoms, and maintain quality of life. There is no medication that stops or reverses ALS, but various approaches can slow progression or prevent complications. Treatment is always tailored: what works for one person may be less suitable for another.
Medications that address the disease itself
**Riluzole**
ProveniIncluded in official guidelines, or approved by EMA or FDA
This medication inhibits the release of glutamate, a substance that damages nerve cells. Riluzole is classified in the medication class of glutamate antagonists. Studies show that it can slow ALS progression by several months. It works modestly, but has been the standard treatment since the 1990s and is included in all international guidelines.
Known side effects include nausea, fatigue, and elevated liver values. For this reason, liver values are checked regularly. Most side effects are mild and disappear after adjustment.
**Edaravone**
ProveniIncluded in official guidelines, or approved by EMA or FDA
This antioxidant works against harmful free radicals in nerve cells. Edaravone is administered intravenously and has been accepted earlier, particularly in Asia; in Europe, the approval process was recently completed. Studies suggest that in early, rapidly progressive ALS (especially bulbar), it can slow decline by approximately 33%.
Side effects include skin reactions at injection sites, headache, and elevated uric acid levels. Here too: most effects are temporary.
**Natalizumab**
ResearchediPositive results in clinical studies, not yet standard treatment
This medication works on the immune system and reduces inflammatory activity in the nervous system. It is known from the treatment of multiple sclerosis. Small studies in ALS suggest that it may work favorably in certain forms (especially those with strong inflammatory characteristics).
The principal side effects are infectious complications because immune defense is weakened. For this reason, natalizumab requires regular monitoring. Further research must determine for which ALS patients this medication truly offers benefit.
**Interleukin-6 directed research**
ResearchediPositive results in clinical studies, not yet standard treatment
Recent studies indicate that interleukin-6, an inflammatory protein, plays a role in ALS progression. Studies on selective inhibition of interleukin-6 signaling are ongoing. This is not yet standard treatment, but the approach aligns with increasing understanding of neuroinflammation (inflammatory phenomena in the nervous system) in ALS.
These approaches are still in the research phase and are therefore not available for standard use.
Symptom management
**Medications for spasticity (increased muscle tone)**
ProveniIncluded in official guidelines, or approved by EMA or FDA
When muscles feel stiff and tense, medications such as baclofen or tizanidine can help relax them. These medications inhibit certain nerve impulses. They serve to prevent stiffness from hindering movement and comfort. Known side effects are fatigue, dizziness, and in severe cases muscle weakness. Dosing and application are always tailored.
**Medications for muscle cramps**
ProveniIncluded in official guidelines, or approved by EMA or FDA
Involuntary, painful muscle contractions occur in many ALS patients, especially in the legs and hands. Quinine sulfate or magnesium supplementation can reduce these, although evidence is mixed. In some patients, weak evidence also supports certain muscle relaxants. The doctor will determine which approach is appropriate.
**Medications for saliva production**
ProveniIncluded in official guidelines, or approved by EMA or FDA
When swallowing becomes more difficult, saliva can accumulate and lead to annoying drooling. Anticholinergic medications (which inhibit saliva production) can reduce this. Botulinum toxin injections into the salivary glands or atropine eye drops (unconventional, but sometimes used) also help. Side effects of anticholinergics include dry mouth, constipation, and confusion.
**Medications for emotional lability**
ProveniIncluded in official guidelines, or approved by EMA or FDA
Some ALS patients experience unexpected, intense laughing or crying episodes, independent of their mood. This is called pseudobulbar affect. Combinations of amitriptyline and dextromethorphan or fluoxetine can reduce this effect. Side effects include dry mouth, constipation and sometimes drowsiness.
**Medicines for depression and anxiety**
ProveniIncluded in official guidelines, or approved by EMA or FDA
ALS is often accompanied by emotional burden. SSRIs (selective serotonin reuptake inhibitors) are frequently prescribed. They reduce anxiety and depression. Side effects can include nausea, sexual problems and apathy, usually temporary after adaptation.
Supportive techniques and interventions
**Non-invasive ventilation (NIV)**
ProveniIncluded in official guidelines, or approved by EMA or FDA
When the breathing muscles become weaker, a mask (nose or face) connected to a ventilator can blow oxygen and air into the lungs at night or during the day. This expands the airways and reduces the workload of the weakened muscles. NIV can extend life and improve sleep quality.
Adaptation requires effort, and some experience claustrophobic discomfort from the mask. Regular monitoring and adjustments are needed.
**Percutaneous endoscopic gastrostomy (PEG)**
ProveniIncluded in official guidelines, or approved by EMA or FDA
When swallowing becomes severe and malnutrition threatens, a tube can be placed directly from the mouth or nose to the stomach, or a hole can be made in the abdominal wall through which nutrition is delivered. This ensures adequate food intake and prevents aspiration (food in the lungs).
The procedure itself is routine, but requires preparation. Complications are rare but possible: infection or leakage around the tube.
**Cervical epidural spinal stimulation**
ResearchediPositive results in clinical studies, not yet standard treatment
Researchers are investigating whether electrical stimulation of nerve roots in the neck can preserve certain functions, particularly auxiliary functions such as coughing and breathing. This is experimental and has limited availability. Risks include infection and damage to nerve roots.
Cell and gene therapy approaches
**Stem cell therapy and derived products**
ResearchediPositive results in clinical studies, not yet standard treatment
Studies are investigating whether stem cells or vesicles (small sac-like structures) derived from them can slow down damage. Animal models sometimes show benefit, but human studies are still limited. A recent analysis bundle shows modest effects in some studies, but much research is of low quality.
Side effects vary greatly depending on how they are administered. This approach is not standard available and only in study setting.
**TDP-43-targeted therapy**
ExperimentaliOngoing in study setting, outcome still unknown
TDP-43 is a protein that is incorrectly positioned in most ALS patients and accumulates. Researchers are developing antibodies or intracellular blockers to counteract this. Studies in cell models and animals show promise, but human application is still in its infancy.
This concerns fundamental research; clinical application is not yet near.
**Gene therapy (C9orf72, SOD1-related)**
ExperimentaliOngoing in study setting, outcome still unknown
For the small group with hereditary ALS mutations (such as C9orf72 or SOD1), researchers are investigating gene therapy to disable or balance the faulty genes. Early results in animal models are promising, but adaptations for human use will require many years.
These approaches are not available for direct application.
Complementary and controversial approaches
**Ivermectin**
Advised againstiProven ineffective or harmful, or dangerous in combination with your treatment
This antiparasitic drug circulated on social media as a possible ALS inhibitor, but studies have shown no benefit. Uncontrolled use can be harmful. A recent analysis concludes there is insufficient evidence and that recommending it would be irresponsible.
**Other widely discussed medicines**
UnproveniNo scientific evidence that it works
Numerous substances (from herbs to dietary supplements) are claimed to help with ALS. Without strong research, their effectiveness is not established, and some can have harmful interactions with regular medicines.
Integrated care approach
In addition to medication and procedures, support from speech therapy (for speech and swallowing), physiotherapy (for muscle function and mobility), occupational therapy (for daily adjustments) and psychosocial support is essential. Nutrition, breathing control and psychological help also contribute to the best possible course of the disease.
_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._