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Ozone is an oxidizing agent which has some surprisingly plausible mechanisms by which it could influence ALS progression. It can also be dangerous. The FDA has warned against using it as a treatment for any disease. Further studies are needed to determine whether there is any dose or route of administration that might be safe and effective for use in people with ALS.

Astaxanthin is a naturally occurring chemical which has plausible mechanisms for treating ALS and appears reasonably safe and well tolerated in non-ALS trials. We look forward to ALS-specific trials planned later this year which should shed important light on whether this is specifically safe for people with ALS, and whether it really can slow ALS progression.

Dr. Martin Turner is a Professor of Clinical Neurology & Neurosciences at the University of Oxford and Dr. Michael Benatar is a Professor of Neurology and Chief of the Neuromuscular Division and Executive Director of the ALS Center at the University of Miami. They will be discussing their recent publication “Neurofilament light chain in drug development for amyotrophic lateral sclerosis: a critical appraisal”, and the potential role of NfL as a biomarker for ALS. This is part I of a two part series.

Dr. Martin Turner is a Professor of Clinical Neurology & Neurosciences at the University of Oxford and Dr. Michael Benatar is a Professor of Neurology and Chief of the Neuromuscular Division and Executive Director of the ALS Center at the University of Miami. They will be discussing their recent publication “Neurofilament light chain in drug development for amyotrophic lateral sclerosis: a critical appraisal”, and the potential role of NfL as a biomarker for ALS. This is part II of a two part series.

There is a theorized association between mycobacteria and ALS, and two published case reports described improvements in ALS-like conditions (both with atypical features) after treatment with antimycobacterial antibiotics. Here we review these in detail and discuss our thoughts on how they might change our approach in certain patients in the future.

Corticosteroids are a class of medications with well-studied effects on the immune system and some people living with ALS have reported benefits from them online. Here we review the pre-clinical and clinical data. We conclude that there is currently no clear evidence that steroids can slow ALS progression, and they can have many side effects.

Butyrates have plausible mechanisms for slowing ALS progression and positive pre-clinical studies. One trial suggests that sodium phenylbutyrate (NaPB) in combination with Tauroursodeoxycholic acid (TUDCA) can slow ALS progression and prolong survival, but the specific contribution of NaPB toward this effect is unclear. Butyrates appear reasonably safe for use in humans. Based on the above information, we support a trial of a butyrate in PALS, but we cannot yet recommend one as a treatment.

Methylcobalamin is a specific precursor to B12 (cobalamin). It has promising mechanisms by which it could slow ALS progression. Two trials done in Japan suggest that 50mg via intramuscular injection twice weekly can slow ALS progression and prolong survival. Here we discuss the evidence for ultra-high dose methylcobalamin in patients with ALS and conclude that it may offer benefit, but only if administered within the first year of symptoms. If started after the first year, there is no evidence of benefit. It appears reasonably safe.

Dr. Jim Caress is a Professor of Neurology at Wake Forest University and Dr. Michael Benatar is a Professor of Neurology and Chief of the Neuromuscular Division and Executive Director of the ALS Center at the University of Miami. They will be discussing their recent publication titled “Harnessing the power of the electronic health record for ALS research and quality improvement: CReATe CAPTURE-ALS and the ALS Toolkit”.

Dr. Mary-Louise Rogers is an Associate Professor at the College of Medicine and Public Health at Flinders University and Dr. Michael Benatar is a Professor of Neurology and Chief of the Neuromuscular Division and Executive Director of the ALS Center at the University of Miami. They will be discussing their recent publication titled “Urinary neopterin: A novel biomarker of disease progression in amyotrophic lateral sclerosis,” which discusses the importance of biomarkers in ALS.

Dr. Marc Weisskopf is the Cecil K. and Philip Drinker Professor of Environmental Epidemiology and Physiology at Harvard T. H. Chan School of Public Health. In this interview, he discusses his recent publication titled “Occupational lead exposure and survival with amyotrophic lateral sclerosis,” which discusses the role that environmental risk factors could play in ALS.

Dr. Melissa Nel is a Research Fellow, and Dr. Jeannine Heckmann a Professor of Neurology, both at the University of Cape Town in South Africa. In this interview, they discuss their recent publication titled “Revealing the Mutational Spectrum in South Africans with Amyotrophic Lateral Sclerosis” which highlights that ALS patients of African genetic ancestry should be included in large-scale ALS gene discovery efforts.

Vitamin C is a very popular supplement in people living with ALS, perhaps due to its antioxidant mechanism, low cost, and low risk. Here we review the data on Vitamin C in ALS in hopes of helping patients make more informed decisions about it.

Melatonin is a naturally occurring hormone, and it is commonly taken as a supplement to induce sleep. Here we review some surprising mechanisms, pre-clinical data and case reports supporting its potential as an ALS treatment.

Light therapy has surprisingly plausible mechanisms through which it could influence the progression of ALS. Here we describe these, as well as some limited pre-clinical and clinical data, and information about dosing, risks, and costs.

Ketogenic diets, resulting in the formation of ketone bodies, have long been used to promote weight loss and to treat refractory epilepsy. Here we summarize the available data on ketogenic diets as a treatment for ALS.

Dr. Michael Benatar is the Walter Bradley Chair in ALS Research, a Professor of Neurology at the University of Miami Miller School of Medicine and the Principal Investigator of the CReATe Consortium. In this interview, he will discuss the CReATe Consortium’s recent paper titled "Validation of serum neurofilaments as prognostic and potential pharmacodynamic biomarkers for ALS". The interview highlights the specific ways in which validated biomarkers could benefit therapeutic development for ALS.

Dr. Corey McMillan is an Associate Professor of Neurology at the University of Pennsylvania and this interview will be discussing his recent paper titled “Machine learning suggests polygenic risk for cognitive dysfunction in amyotrophic lateral sclerosis (ALS)” which discusses the contribution of genetics to heterogeneity we observe in ALS.

Dr. Benjamin Murdock is a Research Assistant Professor of Neurology at the University of Michigan and this interview will be discussing his recent paper titled “NK Cells associated with ALS in a sex- and age-dependent manner” which further expands his ongoing research examining the impact of sex and age on immune mechanisms in ALS.

Tamoxifen is an FDA approved estrogen receptor modulator that is currently prescribed to treat breast cancer. Here we review surprising evidence that it could someday be an ALS treatment, including its mechanisms of action, pre-clinical data, cases, trials and risks.