What is the disease-modifying therapy for amyotrophic lateral sclerosis?

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In ALS, disease-modifying therapy aims to slow the progression of motor neuron loss and extend survival, not just relieve symptoms. Riluzole works by dampening glutamate-driven excitotoxicity, a process thought to contribute to motor neuron degeneration in ALS. By inhibiting presynaptic glutamate release and modulating neuronal excitability, riluzole modestly slows functional decline and can extend survival by a few months, making it the best-established disease-modifying option. It is taken by mouth and requires liver function monitoring due to potential hepatotoxicity.

Baclofen and tizanidine, in contrast, are used to treat spasticity and cramps; they do not alter the disease course. Edaravone is another agent with disease-modifying effects in some patients, but its benefits are more variable and situational, so riluzole remains the classic disease-modifying therapy most often highlighted.