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  • Updated 07.10.2023
  • Released 06.21.1996
  • Expires For CME 07.10.2026

Amyotrophic lateral sclerosis



Amyotrophic lateral sclerosis is a devastating neurodegenerative disease characterized by progressive muscle weakness without notable sensory loss. There are four United States Food and Drug Administration (FDA) approved medications. Riluzole (1995) was the first drug approved followed by edaravone (2017) and sodium phenylbutyrate/taurursodiol (2022). Most recently, tofersen (2023) has been approved to treat ALS patients with a mutation in the SOD1 gene. In this article, the authors review clinical manifestations, risk factors, disease-modifying treatments, symptomatic managements, and clinical trials and provides updates on genetic discoveries.

Historical note and terminology

Aran believed this syndrome was a muscular disease and was the first to use the term “progressive muscular atrophy” (12). Cruveilhier first noticed the atrophy of the anterior spinal roots and thought progressive muscular atrophy was a myelopathic disorder (Cruveilhier 1853). Charcot and Joffroy proposed the term “amyotrophic lateral sclerosis” when they noticed the involvement of the corticospinal tract (33). Brain used the term “motor neuron disease” to emphasize the connections between progressive muscular atrophy, amyotrophic lateral sclerosis, and progressive bulbar palsy (24). The term “motor neuron disease” also highlights the variety of involvement of upper and lower motor neurons. Rowland suggested using the plural form, “motor neuron diseases,” to describe all of the diseases of the anterior horn cells and the motor system, including spinal muscular atrophies (175). Spinal muscular atrophies are clinically and pathologically distinct from amyotrophic lateral sclerosis.

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