ALS has no cure, but a combination of medications, breathing support, nutritional care, and assistive technology can slow the disease, manage symptoms, and preserve quality of life for months or years longer than the disease would otherwise allow. Treatment works best when coordinated through a multidisciplinary clinic, where patients see neurologists, respiratory therapists, dietitians, speech therapists, and physical therapists in a single visit. A Spanish study of nearly 400 patients found that those treated in multidisciplinary clinics survived a median of 40 months compared to 34 months for those seeing a general neurologist alone. For people with bulbar-onset ALS, the difference was even larger: 34 months versus 24.
Medications That Slow the Disease
Riluzole is the longest-standing FDA-approved treatment for ALS. It works by reducing the activity of glutamate, a chemical messenger that can overstimulate and damage nerve cells. The standard dose is 50 mg twice daily, taken on an empty stomach. Clinical trials and subsequent analyses show riluzole extends median survival by about 2 to 3 months and increases the chance of living an additional year by roughly 9%. That may sound modest, but riluzole remains a cornerstone of ALS treatment because those months compound with other interventions.
Edaravone, sold under the brand name Radicava, is the other FDA-approved medication. It acts as an antioxidant, reducing cellular damage in motor neurons. In a six-month trial, patients receiving edaravone lost about 5 points on a 48-point functional scale, compared to 7.5 points in the placebo group. That 33% reduction in functional decline is meaningful in daily terms: it can mean holding onto the ability to button a shirt or climb stairs for longer. Edaravone is given intravenously in cycles. The first cycle involves daily infusions for 14 days followed by 14 days off. After that, each cycle consists of 10 infusion days within a 14-day window, then another 14 days off. An oral formulation is also available.
One drug you may have heard about, Relyvrio, was voluntarily withdrawn from the U.S. market by its manufacturer in October 2024 after a larger Phase 3 trial failed to confirm the benefits seen in earlier studies. It is no longer available.
Targeted Therapy for SOD1 Mutations
About 2% of people with ALS carry a mutation in the SOD1 gene. For them, tofersen (brand name Qalsody) offers a more targeted approach. Tofersen is injected into the spinal fluid and works by blocking the faulty gene’s instructions, reducing levels of the toxic protein it produces. In a Phase 3 trial published in the New England Journal of Medicine, tofersen significantly lowered both the harmful SOD1 protein in spinal fluid and a key marker of nerve damage in the blood. Genetic testing is needed to determine eligibility, so if you haven’t been tested for ALS-related gene mutations, it’s worth asking your neurologist.
Breathing Support
As ALS weakens the muscles involved in breathing, respiratory support becomes one of the most important parts of treatment. Non-invasive ventilation (NIV), typically delivered through a mask worn over the nose or face, helps maintain oxygen levels and offload tired breathing muscles. It is usually the single intervention with the greatest impact on both survival and comfort.
A European Respiratory Society study found that median survival after starting NIV was about 354 days overall, but patients who used NIV for more than four hours per night survived a median of 479 days, roughly four months longer. Despite that benefit, adherence is a challenge. Three months after starting, the median use was just one hour per night, and 43% of patients weren’t using it at all. Building up gradually, working with a respiratory therapist to find a comfortable mask, and understanding the survival benefit can all help with consistency.
Lung function is typically monitored using forced vital capacity (FVC), a simple breathing test that measures how much air you can forcefully exhale. Your care team will track this number at each visit to guide decisions about when to start NIV and when to discuss more advanced options.
Nutritional Care and Feeding Tubes
Weight loss in ALS is common and dangerous. Difficulty swallowing, fatigue from eating, and the body’s increased energy demands all contribute. Maintaining weight is directly linked to slower disease progression and longer survival, so nutrition deserves as much attention as any medication.
Early strategies include softening food textures, thickening liquids to reduce choking risk, eating smaller and more frequent meals, and working with a dietitian to increase calorie density. When swallowing becomes too difficult or weight loss exceeds 10% of your baseline body weight, guidelines from both the American Academy of Neurology and the European Federation of Neurological Societies recommend placing a feeding tube (called a PEG tube) before lung capacity drops below 50% of normal. Timing matters because the procedure carries more risk once breathing muscles are significantly weakened. A PEG tube doesn’t mean you stop eating by mouth entirely. Many people use it to supplement meals or take in calories and fluids when swallowing is too exhausting.
Managing Day-to-Day Symptoms
ALS produces a range of symptoms beyond muscle weakness, and treating them makes a real difference in daily comfort.
- Excessive saliva (sialorrhea): Weakened swallowing muscles cause saliva to pool, which can be distressing and cause skin irritation. First-line treatments include medications that dry secretions, such as amitriptyline or glycopyrrolate. Skin patches and drops placed under the tongue are other options. For cases that don’t respond, injections into the salivary glands can reduce saliva production significantly.
- Uncontrollable laughing or crying: Called pseudobulbar affect, this happens when ALS damages the brain circuits that regulate emotional expression. Episodes don’t match what you’re actually feeling, which can be confusing and isolating. A combination medication specifically approved for this symptom can reduce episodes substantially.
- Muscle cramps and stiffness: These are especially common early in the disease. Stretching, physical therapy, and certain medications can help keep muscles more comfortable and flexible.
- Fatigue: Energy conservation strategies, such as spacing out activities and using adaptive equipment, help you do more with less effort.
Communication Technology
Losing the ability to speak is one of the most feared aspects of ALS, but augmentative and alternative communication (AAC) devices can preserve your ability to express yourself well into the later stages of the disease. The key is to start early, before speech is significantly affected, so you can learn the technology while it’s still easy to practice.
In the early stages, speech-generating apps on tablets or phones may be enough. As hand and arm function declines, eye-tracking systems become the primary tool. These devices follow your gaze across a screen, letting you select letters, words, or phrases just by looking at them. Research shows eye-gaze and eye-tracking technologies account for the majority of communication strategies studied in ALS, appearing in roughly two-thirds of published approaches. For people who eventually lose voluntary eye movement (a state sometimes called locked-in), brain-computer interfaces that read electrical brain signals are an emerging option, though they remain less widely available.
Many people also choose to “bank” their voice early after diagnosis, recording phrases that can later be used by speech-generating software to create a synthetic voice that still sounds like them.
Physical and Occupational Therapy
Exercise in ALS is a balancing act. Moderate, regular activity helps maintain range of motion, reduces stiffness, and supports mood without accelerating muscle damage. A physical therapist experienced with ALS can design a program that adapts as the disease progresses, shifting from active exercises to passive stretching and positioning as needed.
Occupational therapists focus on keeping you independent for as long as possible. This includes recommending grab bars, shower chairs, and dressing aids early on, then progressing to powered wheelchairs and home modifications as mobility changes. Getting equipment in place before you urgently need it makes transitions smoother and safer.
Clinical Trials
Because current treatments extend life by months rather than years, many people with ALS choose to participate in clinical trials. One upcoming Phase 3 trial, called PREVAiLS, will begin recruiting in early 2026 to test pridopidine, a drug that emerged from the HEALEY ALS Platform Trial. The HEALEY trial itself is a novel structure that tests multiple potential treatments simultaneously, speeding up the process of identifying what works. Your multidisciplinary clinic or organizations like the ALS Association can help you find trials that match your disease stage, genetic profile, and location.