Syphilis may be a confounding factor, not a causative agent, in syphilitic ALS.
Based upon a review of published clinical observations regarding syphilitic amyotrophic lateral sclerosis (ALS), I hypothesize that syphilis is actually a confounding factor, not a causative factor, in syphilitic ALS. Moreover, I propose that the successful treatment of ALS symptoms in patients with syphilitic ALS using penicillin G and hydrocortisone is an indirect consequence of the treatment regimen and is not due to the treatment of syphilis. Specifically, I propose that the observed effect is due to the various pharmacological activities of penicillin G (e.g., a GABA receptor antagonist) and/or the multifaceted pharmacological activity of hydrocortisone. The notion that syphilis may be a confounding factor in syphilitic ALS is highly relevant, as it suggests that treating ALS patients with penicillin G and hydrocortisone-regardless of whether they present with syphilitic ALS or non-syphilitic ALS-may be effective at treating this rapidly progressive, highly devastating disease.
Leiden Academic Center for Drug Research (LACDR), Leiden University, Leiden, 2333 CC, Netherlands; Ry Pharma, Hofstraat 1, Willemstad, 4797 AC, Netherlands.
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ALS; GABA antagonist; amyotrophic lateral sclerosis; benzylpenicillin; circadian rhythm; hydrocortisone; penicillin G; syphilitic ALS