Neuroprotective vs. Neurostimulating Management Options for Amytrophic Lateral Sclerosis. A Multiple Trial Based Comparison

Doctoral Thesis / Dissertation from the year 2017 in the subject Medicine - Internal Medicine, grade: PG MEDICAL DOCTOR & CEO, University of Buckingham (Ealing Hospital London), course: Doctor Of Clinical Internal Medicine (MD), language: English, abstract: LS, an incurable fatal syndrome (than being just a misnomer of disease), affecting each organ system and life (quality and quantity), through glutamate induced free radical and electrical injuries to nerves. This giant needs to be further dig into, with deeper investigations for newer management options and betterment of previous treatments, aiming a comparison of various strategies, to invent most sustainable and suitable choice for PALS.

Broadly ALS can be classified as sporadic and familial, based on aetiology. There are various subtypes in each of them with regard to the genetic, pathological and nucleic acid mutational conflicts. Like in a case of "Diabetes Mellitus", we don't haphazardly enlist all drugs and precautions, instead first classify them into pharmaco-therapeutic or lifestyle changes, similarly for ALS, I've proposed for a new management classification system for clinical purposes after feeling a need of such, near the end of dissertation. Only approved and unavoidable option in present scenario is glutamic acid release inhibitor
"Riluzole" and the basic or standard life care for the disease. Broad spectrum antibiotic "Ceftriaxone" has been found to cross the blood brain barrier and increase GLT-1 channel, leading to fall in glutamate levels of nervous system and hence can be an add-on option to benefit more. RPPX: Dexpramipexole; recently developed drug especially for SOD-1 and TDP-43 mutation ALS, showed mitochondrial protection and reciprocated it as improved ALSFRS. Though the medication can be a future option, but for now trials have failed to reflect major benefit on a 12-month follow up.

MCI186: Edaravone, by virtue of being antioxidant in character (supposedly); has gained FDA approval in 2017 due to promising results. Drug has been in use in USA since May 2017 and will be introduced in European market following political, copyright and legal decisions in time. Tirasemtiv activates muscle troponin complex leading to increased sensitivity of neuromuscular junction (NMJ) for calcium (Ca2+) and hence help to overcome the fatigue of ALS. Study is yet undergoing with biggest hope amongst all newer options. DPS using local electrodes in diaphragm, overcome respiratory efforts in ALS affected patients. Being an "HDE" due to dramatic symptomatic relief, it's being considered in guidelines, even after multiple failed trial results on 12 month follow up and absolutely no effect on survival and disease progression.