Amyotrophic lateral sclerosis: current practice and future treatments.
OBJECTIVE
Knowledge of amyotrophic lateral sclerosis, and in particular the care of patients with it, is evolving exponentially. More than 1700 articles with the phrase 'amyotrophic lateral sclerosis' have been published in the past 2 years; these form the basis for this timely review.


RESULTS
In part 1, I give an update on the care of patients with amyotrophic lateral sclerosis, including ways to speed diagnosis, optimal use of riluzole, multidisciplinary teams, mechanical ventilation, gastrostomy tubes, lipid-lowering agents and symptom management. Although care has become more evidence-based, there remain a number of quandaries; for these, I will provide suggestions based upon my own experience. In part 2, I identify some exciting new treatment options that are under study. These include agents designed for novel targets within motor neurons and nonneuronal cells, agents designed for specific amyotrophic lateral sclerosis subtypes and interesting new technologies. Finally, in part 3, I define current barriers to developing even better therapeutics and offer ways around them.


CONCLUSIONS
The care of patients with amyotrophic lateral sclerosis has evolved and is now more evidence-based than ever before. Exciting new therapies are currently being tested, which may revolutionize care even further. Barriers exist, but they are surmountable.
Bedlack
Richard S
RS
Neurology Section, Division of Neurology, Duke University, Durham Veterans Affairs Medical Center, Durham, North Carolina 27707, USA. Bedla001@mc.duke.edu
D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis / Q000628:therapy; D015415:Biomarkers; D003072:Cognition Disorders / Q000175:diagnosis; D019317:Evidence-Based Medicine; D005544:Forecasting; D006801:Humans; D018696:Neuroprotective Agents / Q000627:therapeutic use; D010166:Palliative Care; D019782:Riluzole / Q000627:therapeutic use; D015996:Survival Rate
D015415:Biomarkers; D018696:Neuroprotective Agents; D019782:Riluzole