Treatments for ALS: What Are the Options?

Quick note: This article is for educational purposes and isn’t medical advice. ALS treatment decisions are highly personal and should be made with an ALS-experienced care team.

ALS (amyotrophic lateral sclerosis), also known as Lou Gehrig’s disease, is the kind of diagnosis nobody puts on a vision board. It affects the nerve cells that control voluntary musclesthings you usually don’t think about until your body reminds you, loudly, that you’ve been taking them for granted.

Here’s the good news (yes, we’re starting with good news): while there still isn’t a cure, there are treatment options that can help people live longer, function better, and feel more like themselves day to day. Even when a medication can only slow things “a little,” that “little” can mean extra time, fewer scary nights, and more moments that feel normalwhatever “normal” looks like now.

This guide breaks down the real-world treatment toolkit: FDA-approved medications, breathing and nutrition support, symptom relief, assistive tech, multidisciplinary care, and clinical trials.

The Big Picture: Two Treatment Goals

Most ALS treatment plans mix two approaches:

1. Disease-modifying treatments to slow progression (think: “tap the brakes,” not “reverse the car”).
2. Supportive and symptom-based care to preserve function, comfort, and quality of life (think: “make daily life easier, safer, and more doable”).

One of the most important “treatments” isn’t a pill at all: getting care through a multidisciplinary ALS clinica coordinated team that typically includes neurology, respiratory therapy, speech-language pathology, nutrition, OT/PT, social work, and palliative care. Studies have found that centralized multidisciplinary care is associated with improved outcomes, including survival. In plain English: it helps. A lot.

FDA-Approved Medications That May Slow ALS Progression

In the U.S., there are a few medications used to slow ALS progression in certain ways. They don’t work for everyone the same way, and they don’t stop ALS entirelybut they can matter.

1) Riluzole (Rilutek and generics; also oral film/liquid forms)

What it does: Riluzole is widely used as a foundational ALS medication. It’s believed to reduce motor neuron damage by decreasing glutamate-related toxicity (glutamate is a neurotransmitter, but too much of a good thing can be a bad thing for neurons).

What to expect: Research reviews and guideline discussions generally describe a modest survival benefit on average. “Modest” doesn’t mean “meaningless”it means the effect is measured in months for many people, and the benefit varies person to person.

How it’s taken: Typically by mouth, usually twice daily (your clinician will confirm dosing and whether a liquid or alternative formulation makes swallowing easier).

Common monitoring: Liver function tests are often monitored because riluzole can affect liver enzymes.

2) Edaravone (Radicava IV and Radicava ORS)

What it does: Edaravone is thought to work as an antioxidanthelping counter oxidative stress that may contribute to motor neuron injury.

What to expect: In the trial that supported its original approval, participants on edaravone declined less on a standard ALS functioning scale over 24 weeks compared with placebo.

Forms:

• IV infusion (the original form approved in 2017)
• Oral suspension (Radicava ORS) approved in 2022, which can be taken by mouth or via feeding tube and is designed for at-home use with the same cycle-style dosing schedule (your clinician will spell out the “on” and “off” days).

Side effects and cautions: Bruising, gait issues, and headaches are among the commonly reported side effects; allergic reactions can occur, and people with sulfite sensitivity need special caution.

3) Tofersen (Qalsody) for SOD1-ALS

Who it’s for: Qalsody is for adults with ALS associated with a mutation in the SOD1 gene (a specific genetic subtype).

What it does: It’s an antisense oligonucleotide therapy that targets SOD1 mRNA to reduce the production of abnormal SOD1 protein.

How it’s given: By intrathecal injection (a spinal injection/lumbar puncture) on a schedule with loading doses followed by maintenance dosing.

Approval notes: Qalsody received accelerated approval based on reductions in a biomarker (plasma neurofilament light chain), with ongoing studies meant to confirm clinical benefit.

A quick word on RELYVRIO (AMX0035): approved, then withdrawn

If you’ve read older ALS treatment lists, you may see RELYVRIO mentioned. It was FDA-approved in September 2022, but after a Phase 3 trial did not meet its endpoints, the manufacturer requested withdrawal, and FDA withdrew approval effective August 29, 2025.

Breathing Support: Often the Biggest Quality-of-Life (and Survival) Lever

When ALS weakens breathing muscles, respiratory support becomes a cornerstone of care. Medications matterbut breathing support can be the “heavy hitter” because it directly addresses respiratory failure, which is a common cause of death in ALS.

Noninvasive ventilation (NIV): BiPAP and similar devices

What it is: A mask-based device that supports breathing, often used at night first.

Why it helps: Evidence and clinical experience show NIV can improve comfort and is associated with better survival; an editorial review of the classic randomized trial describes a median survival benefit.

Real-life example: Someone who wakes up with headaches, vivid dreams, or daytime sleepiness may discover (through testing) nighttime hypoventilation. Starting NIV can improve sleep quality, morning energy, and that “I ran a marathon in my sleep” feeling.

Cough assistance and secretion management

Weak cough = trapped secretions = infections that nobody has time for. Devices like mechanical cough assist, plus suction and breathing exercises recommended by respiratory therapy, can reduce complications and make breathing feel less like work.

Invasive ventilation (tracheostomy)

When noninvasive support is no longer enough, some people consider tracheostomy ventilation. It’s a deeply personal decision involving goals, caregiving resources, communication options, and quality-of-life preferences. A good team will walk through the pros, cons, and logistics without rushing you.

Nutrition and Swallowing: Calories Are a Clinical Strategy

ALS can increase calorie needs while making eating harderan unfair combo. Nutrition support aims to prevent weight loss, maintain strength, and reduce choking/aspiration risk.

Nutrition support with a dietitian

Many ALS clinics emphasize high-calorie, high-protein strategies, texture modifications, and safe-swallow techniques. The goal is not “perfect clean eating.” The goal is “enough nutrition to keep you going.” (If someone tries to shame you for milkshakes during ALS, you have permission to ignore them professionally.)

Feeding tubes (PEG/G-tube)

What it does: A feeding tube can supplement or replace oral intake to maintain nutrition and hydration, and it can also make medication administration easier.

Timing matters: Many guidelines encourage considering feeding tube placement before breathing capacity becomes too low, because procedure risk can increase as respiratory function declines.

Important nuance: Feeding tubes aren’t “giving up.” They’re a toollike glasses, but for eating. Some people still eat by mouth for pleasure while using the tube for calories and hydration.

Mobility, Daily Function, and Independence

Supportive care is where ALS treatment gets incredibly practical. The goal is to keep you doing what matterssafelyfor as long as possible.

Physical therapy (PT) and occupational therapy (OT)

PT can help with stretching, range of motion, fatigue management, and safe movement strategies. OT focuses on daily tasksdressing, bathing, cooking, computer useusing adaptive equipment and smart home tools. Think: work smarter, not harder, because your muscles are already working overtime.

Assistive devices

• Braces (for foot drop or wrist weakness)
• Mobility aids (canes, walkers, wheelchairsmanual or power)
• Home modifications (ramps, shower chairs, grab bars, stair solutions)

A common misconception is “I’ll wait until I really need it.” But early adoption can prevent falls, save energy, and reduce fear. Using a power chair isn’t surrenderit’s strategy.

Speech therapy and communication technology

Speech-language pathologists help with swallowing safety and communication options. Many people explore voice banking or message banking early, then transition to speech-generating devices as needed. A modern AAC device can be as simple as a tablet app or as advanced as eye-gaze technology.

Symptom Management: Small Fixes, Big Relief

ALS symptoms can be wide-ranging, and treating them doesn’t “just” improve comfortit can preserve function and reduce complications.

Drooling (sialorrhea)

Drooling in ALS often happens because swallowing is hardernot because the body is producing oceans of saliva. Treatment options include behavioral strategies, medications (often anticholinergics), and for more stubborn cases, procedures like botulinum toxin injections into salivary glands.

Spasticity, cramps, and stiffness

Muscle tightness and spasms can be treated with stretching programs and medications (your clinician may consider options like baclofen or tizanidine depending on the situation). The “right” plan balances relief with side effects like sleepiness or weakness.

Pseudobulbar affect (PBA)

PBA can cause sudden episodes of laughing or crying that don’t match how someone feels. Dextromethorphan/quinidine (brand: NUEDEXTA) is approved to treat PBA and has shown benefit in people with neurologic conditions including ALS.

Pain, anxiety, depression, and sleep

These are not “side issues.” They’re part of the disease experience and deserve treatment. Options can include counseling, medications, sleep-focused respiratory support, positioning strategies, and palliative care tools. Comfort and mental health are legitimate clinical goalsfull stop.

Palliative Care: Not “End-of-Life,” but “Quality-of-Life”

Palliative care is often misunderstood as something you only get at the finish line. In ALS, it can be valuable from early onhelping manage symptoms, coordinate support, and navigate complex decisions. Evidence-based ALS care frequently includes riluzole, multidisciplinary care, noninvasive ventilation, timely feeding support, and symptom management alongside palliative involvement.

Planning ahead can cover topics like communication preferences, emergency plans, caregiver support, and what matters most to the person with ALS (comfort, time at home, ability to communicate, etc.). The point isn’t to be pessimisticit’s to keep control where you can.

Clinical Trials and Emerging Options

ALS research is active, and clinical trials are a major avenue for accessing experimental therapies while contributing to scientific progress. Trials may focus on:

• Gene-targeted therapies (especially for known genetic ALS subtypes)
• Biomarker-driven treatments (tracking neurofilament light chain or other measures)
• Anti-inflammatory or neuroprotective strategies
• Cell-based approaches (still investigational)
• Respiratory timing and optimization studies

Where people often start: ClinicalTrials.gov is the central U.S. registry for trials, and many ALS clinics can help screen trials that match a person’s subtype, stage, and practical constraints.

Smart questions to ask about a trial:

• What phase is it (Phase 1, 2, 3)?
• What’s the goalsafety, dosing, biomarker change, or real-world function/survival?
• Will I need travel, and how often?
• Can I stay on standard ALS meds?
• What are the risks, and how are side effects monitored?

Putting It Together: A Practical Treatment Checklist

If you’re building (or updating) an ALS treatment plan, these are common topics that matter early:

• Medication plan: riluzole? edaravone? genetic testing to see if Qalsody is relevant?
• Respiratory monitoring: baseline testing and repeat checks; timing for NIV.
• Swallowing and nutrition: dietitian support; safe-swallow strategies; feeding tube planning if needed.
• Mobility and safety: fall prevention; braces; power mobility timing; home setup.
• Communication: voice/message banking; AAC options before speech becomes very difficult.
• Symptom relief: drooling, cramps, spasticity, PBA, pain, sleep, mood.
• Support: social work, caregiver resources, palliative care, and local ALS organization support.
• Clinical trials: eligibility screening and what participation would realistically require.

ALS care works best when it’s proactive. Waiting until a problem is “bad enough” often means you’ve already paid the price in fatigue, falls, weight loss, or anxiety. Early planning is not dramaticit’s efficient.

Real-World Experiences: What ALS Treatment Can Look Like (500+ Words)

The stories below are composites based on common patient and caregiver experiences described in ALS clinics and support communities. They’re not any one person’s medical storymore like “here’s how this often plays out in real life.”

Experience #1: “The breathing machine felt scary… until it didn’t.”

One of the most common emotional speed bumps in ALS treatment is the first time someone hears “noninvasive ventilation.” A mask? A machine? At night? It can feel like a preview of a future you didn’t order. But many people who start NIV because of nighttime symptomsmorning headaches, restless sleep, daytime exhaustiondescribe a surprisingly quick pivot: “I didn’t realize how bad my sleep had gotten until it improved.”

What helps is a slow, coaching-style approach. A respiratory therapist adjusts settings, helps find a comfortable mask, and builds tolerance in small steps (like trying it during a calm TV show instead of only at bedtime when anxiety is already high). Over time, NIV shifts from “this is happening to me” to “this is a tool I’m using.” In families, it can also reduce nighttime worrypartners sleep a little easier when breathing feels supported.

Experience #2: “The feeding tube wasn’t the end of eatingit was the end of fighting every meal.”

Feeding tubes are another area where fear and reality don’t always match. Many people delay the conversation because it feels symbolic. But in day-to-day practice, the most common reaction after placement is relief: fewer exhausting meals, less coughing and choking, and less pressure on caregivers to turn every bite into a medical event.

Lots of people keep eating by mouth for pleasuretastes, textures, family mealswhile using the tube for reliable calories, hydration, and medications. The emotional shift can be big: food becomes enjoyable again instead of stressful. Caregivers often say it reduces conflict too. Instead of “Please take a few more bites,” the focus can become, “What sounds good today?”

Experience #3: “Assistive tech gave me my independence back.”

There’s a moment in many ALS journeys when someone realizes that saving energy is just as important as building strength. A brace that reduces tripping, a shower chair that prevents falls, a power wheelchair that turns a draining outing into a doable onethese aren’t luxuries. They’re quality-of-life multipliers.

Communication tools can feel even more personal. People who do voice banking early often describe it like making an insurance policy for their identity: “I wanted my voice to still sound like me.” Later, when speech becomes harder, switching to a speech-generating device can be emotionalbut it can also be empowering. Being able to participate in conversations, advocate for needs, and crack jokes (yes, you can still be funny through a device) restores agency in a situation that tries to take it away.

Experience #4: “The best treatment wasn’t one thingit was a team.”

When people talk about what truly changed their experience, they often point to coordinated multidisciplinary care. Instead of juggling separate appointments and repeating the same story ten times, the ALS clinic model can feel like a single, organized command center. One visit might include a neurologist adjusting medications, a speech therapist recommending safer swallowing strategies, a dietitian building a calorie plan that’s realistic, and a respiratory therapist checking breathing measures.

It also helps families think ahead. Care teams often introduce topics before they’re urgentNIV before breathing is a crisis, communication tools before speech becomes severely limited, and palliative care before symptoms overwhelm. That proactive rhythm can turn ALS care from reactive firefighting into something closer to a plan. Not a perfect planALS is still ALSbut a plan that gives people more stability, fewer surprises, and more control over how they want to live.

Conclusion

ALS treatment today is a mix of medications that may slow progression (like riluzole and edaravone, and Qalsody for SOD1-ALS) plus supportive care that protects breathing, nutrition, communication, and comfort. The most effective approach is usually layered: start with what’s evidence-based, monitor changes early, and adjust proactively with an experienced multidisciplinary team.

If you take one thing from this article, let it be this: ALS care isn’t just about what you “can’t” do. It’s also about building a toolboxone that helps you keep doing what matters, in the way that matters, for as long as possible.