ALS has no cure, but a combination of medications, breathing support, nutritional care, and symptom-specific treatments can slow the disease’s progression and meaningfully improve quality of life. Treatment today looks very different from even a decade ago, with newer drug approvals and a strong emphasis on coordinated, team-based care that has been shown to extend survival by months.
Medications That Slow Progression
Two FDA-approved drugs currently target the underlying progression of ALS rather than just its symptoms. The first, riluzole, has been the standard of care since the mid-1990s. Taken as a daily pill, it reduces the rate of motor neuron damage and is associated with a 35% reduction in mortality in clinical trials. Its greatest measurable benefit appears in the later stages of the disease, extending the time patients remain functional before reaching the most advanced phase.
The second is edaravone, which works by reducing cellular stress on motor neurons. In clinical trials, patients taking edaravone experienced a 33% slower rate of physical functional decline over 24 weeks compared to placebo. It was originally available only through lengthy intravenous infusions on a cycling schedule (10 to 14 days on, then days off), but an oral suspension is now available. The oral form can be taken daily, which simplifies the treatment routine considerably.
A third drug, Relyvrio, was approved in 2022 but voluntarily withdrawn from the market after a larger Phase 3 trial failed to confirm its earlier promise. Its FDA approval was formally withdrawn in August 2025, so it is no longer available.
A Gene-Targeted Option for SOD1 Mutations
About 2% of people with ALS carry a mutation in the SOD1 gene. For those individuals, there is now a targeted therapy called tofersen (brand name Qalsody). It’s delivered through a spinal injection and works by blocking the faulty genetic instructions that cause the SOD1 protein to become toxic to motor neurons.
Tofersen doesn’t yet have a confirmed effect on physical function scores in trials, but it dramatically lowers a key blood marker of nerve damage called neurofilament light chain. In the pivotal study, patients on tofersen saw a 55% reduction in this marker at 28 weeks, while the placebo group saw a 12% increase. That biomarker shift was significant enough for the FDA to grant approval while longer-term studies continue. Genetic testing is required to confirm eligibility, and many ALS clinics now offer it routinely.
Breathing Support
As ALS weakens the muscles used for breathing, respiratory support becomes one of the most important interventions. Non-invasive ventilation (NIV), typically a bilevel positive airway pressure machine worn with a mask, is the primary tool. It assists breathing without surgery and is usually recommended once lung capacity drops below 50% of the predicted normal value.
Timing matters. Starting NIV earlier, when lung capacity is still at or above 65%, and using it for at least four hours a day, is associated with a median survival of 2.7 years from that point, compared to 1.8 years for those who start later. Many people begin using NIV only at night, when breathing naturally weakens during sleep, and gradually increase use as the disease progresses. As respiratory muscles weaken further, some patients transition to invasive ventilation through a tracheostomy, though this is a deeply personal decision that involves weighing long-term quality of life.
Nutritional Support and Feeding Tubes
Swallowing difficulties are common in ALS and can lead to weight loss, dehydration, and aspiration (food or liquid entering the lungs). When eating becomes unsafe or insufficient, a feeding tube placed directly into the stomach, called a PEG tube, can maintain nutrition and hydration safely.
Both American and European neurology guidelines recommend placing a PEG tube after a patient has lost more than 10% of their body weight, but before lung capacity drops below 50%. That second criterion is important because the procedure requires mild sedation, and lower lung function increases the risk. Getting the tube placed earlier, while breathing is still relatively strong, makes the procedure safer and gives people time to adjust before they fully depend on it. Many people continue to eat small amounts by mouth for pleasure even after a PEG tube is in place.
Managing Excess Saliva
When the muscles involved in swallowing weaken, saliva pools in the mouth and can cause drooling, discomfort, and difficulty using breathing devices. This is one of the most common and distressing symptoms in ALS, but several treatments are effective.
The first-line approach uses medications that reduce saliva production. Options include scopolamine patches (effective in about 85% of patients in one study), glycopyrrolate, atropine drops placed under the tongue, and amitriptyline. Data from a large ALS patient database shows that over half of patients respond to one of these medications.
When medications aren’t enough, injections of botulinum toxin into the salivary glands offer another option. The strongest evidence supports injecting the parotid gland, where the effect can last up to four months. The injections can be guided by ultrasound to improve accuracy. For people who don’t respond to any of these approaches, targeted radiation therapy to the salivary glands can reduce saliva production for up to six months, sometimes with just a single treatment session.
Treating Involuntary Laughing or Crying
Up to half of people with ALS experience episodes of uncontrollable laughing or crying that don’t match how they actually feel. This is called pseudobulbar affect, and it results from damage to the brain’s pathways that regulate emotional expression, not from depression or emotional instability.
An FDA-approved combination medication (sold as Nuedexta) treats this effectively. In a clinical trial of 140 ALS patients, those taking the drug had significantly fewer and less severe episodes compared to placebo within just 29 days. The medication works by acting on specific receptors in the brain that help regulate emotional responses. For many people, controlling these episodes is one of the biggest improvements in daily social comfort during the course of the disease.
The Value of Multidisciplinary Clinics
How care is organized matters as much as which treatments are used. Multidisciplinary ALS clinics bring together neurologists, respiratory therapists, physical and occupational therapists, speech-language pathologists, nutritionists, social workers, and palliative care specialists in a single coordinated visit. This isn’t just a convenience. A study comparing outcomes found that patients treated through a multidisciplinary model had a median survival of 40 months, compared to 34 months for those receiving standard neurological care. That six-month difference was statistically significant and likely reflects earlier identification of treatable problems like breathing decline, swallowing difficulty, and nutritional loss.
These clinics also coordinate assistive technology, including speech-generating devices, power wheelchairs, and home modifications, which can preserve independence as the disease progresses. If you or a family member has been diagnosed with ALS, connecting with an ALS Association-certified center or a multidisciplinary clinic is one of the single most impactful steps you can take.
Physical and Occupational Therapy
Exercise doesn’t reverse ALS, but moderate, guided physical activity helps maintain range of motion, reduces painful stiffness, and can slow the loss of functional ability in muscles that are still working. The goal isn’t strength training but rather gentle stretching, assisted movement, and activity modification. Overworking weakened muscles can accelerate fatigue, so therapy programs are tailored carefully to each person’s current ability.
Occupational therapists focus on practical problem-solving: adapting how you grip utensils, get dressed, use a phone, or navigate your home. As hand function changes, they introduce tools like button hooks, weighted utensils, or voice-activated home controls. These interventions are unglamorous but often make the biggest day-to-day difference in maintaining autonomy.