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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.

Spirulina, or blue green algae, is a supplement that is claimed to have antioxidant and anti-inflammatory properties. Here we review the problems we found with the single relevant preclinical ALS study, and some surprising real and potential risks associated with this product.

Lutimax is a supplement containing Luteolin, a flavonoid that has antioxidant, anti-inflammatory and neuroprotective mechanisms. Here we review case reports and a small trial claiming benefits in people with ALS.

Bee Venom contains substances that could plausibly affect the rate of ALS progression, and there are some positive (though flawed) preclinical studies and case reports associated with it. Since it has some potentially severe side effects and has not been tested in an ALS trial, our group advised against using it to try and slow ALS progression.

Vinpocetine is a prescription drug in many countries and is used to treat patients with stroke and memory loss (though meta-analyses have questioned its benefit in these populations). In the USA, it is sold as a nutritional supplement. Here we review the potential mechanisms, data from pre-clinical models, case reports, and a trial, and the safety of vinpocetine as an ALS treatment.

Apoaequorin (also called Prevagen) is a calcium binding protein first isolated from jellyfish. Here we review the theory and the single trial of this compound for treating ALS.

Azathioprine is an immunosuppressant drug. Here we review the mechanisms by which it could slow ALS progression, discuss the ALS reversals and the negative ALS trials associated with this drug, and highlight some of the serious side effects that can occur in patients taking it.

Accilion is a topical mineral cream. Here we discuss why we do not think it has a plausible mechanism of action for treating ALS. We also point out the problems interpreting the one anecdotal report of improvement in ALS symptoms associated with this treatment.