ALS is not currently curable, but treatments exist that slow progression and extend survival

There is no cure for ALS yet. The disease damages motor neurons in ways that current medicine cannot reverse or repair. However, this does not mean nothing works. Two FDA-approved drugs—riluzole and edaravone—have been shown to slow the rate at which ALS progresses, meaning they buy time rather than stop the disease. Other treatments manage symptoms and help people live longer and more comfortably while living with ALS.

The difference between slowing progression and curing matters for how you plan. A cure would stop or reverse the damage. Slowing progression means the disease still moves forward, but more slowly. For some people, a few extra months or years of maintained function changes what they can do—work longer, spend time with family, complete projects that matter to them.

Key Takeaways

  • Riluzole and edaravone are the only drugs proven to slow ALS progression, extending survival by months to a few years depending on the person and the drug.
  • These drugs work best when started early, before significant muscle loss occurs, so early diagnosis matters for outcomes.
  • Symptom management—physical therapy, speech therapy, breathing support, feeding tubes—keeps people functioning longer and reduces suffering even though it does not cure the disease.
  • Multiple clinical trials are testing new approaches, including gene therapy and stem cell treatments, but none have yet proven safe and effective enough for standard use.
  • Genetic testing can identify which form of ALS you have, which affects which treatments might work and what research trials you could join.

How riluzole and edaravone work, and what they actually do

Riluzole has been used since 1995. It reduces the amount of glutamate, a chemical that damages motor neurons when it builds up. In clinical trials, riluzole extended survival by about two to three months on average. That sounds small, but for someone with ALS, two months of maintained speech or swallowing can mean the difference between communicating with family and losing that ability.

Edaravone was approved more recently (2017 in the United States). It works by reducing oxidative stress, a type of cellular damage that kills motor neurons. In trials, edaravone slowed the decline in function by about 33 percent over six months. Again, this is not stopping the disease—it is slowing it. A person still loses function, but more gradually.

Both drugs work best when started early, before too many motor neurons are already dead. Once a neuron dies, no drug can bring it back. This is why people newly diagnosed with ALS are usually started on one of these drugs quickly, even though the benefit is modest. The earlier you start, the more neurons you still have to protect.

Some people take both drugs together, though the evidence for combining them is weaker than the evidence for each one alone. Your neurologist can discuss whether one, both, or neither makes sense for your specific situation.

Why symptom management extends life even without a cure

ALS kills by paralyzing the muscles that control breathing. Before that happens, it affects eating, speaking, walking, and hand function. Treatments that manage these symptoms do not cure ALS, but they prevent the complications that would otherwise end life sooner.

A feeding tube (PEG tube) keeps someone nourished when swallowing becomes unsafe or impossible. Without it, aspiration pneumonia—food or liquid going into the lungs—becomes likely and often fatal. With a feeding tube, that risk drops sharply. Non-invasive ventilation (a mask connected to a machine that helps you breathe) does the same for breathing. It does not cure the paralysis, but it keeps oxygen flowing to the brain and body, extending life by months or years.

Physical therapy and stretching prevent contractures (permanent shortening of muscles and tendons) that cause pain and reduce comfort. Speech therapy helps people communicate longer, even as voice weakens. These are not small things. They are the difference between a person being able to say goodbye and not being able to.

What clinical trials are testing right now

Several approaches are in human trials or moving toward them. Gene therapy aims to fix or replace the faulty genes that cause inherited forms of ALS (like SOD1 and C9orf72). Stem cell therapy attempts to replace dead motor neurons with new ones grown in the lab. Antisense oligonucleotides (short pieces of genetic material) target specific disease-causing genes and reduce the protein they make.

Some of these have shown promise in early-stage trials or in laboratory work, but none have yet proven safe and effective enough to be approved for routine use. Clinical trials take years. A drug that looks promising in a small trial of 20 people may not work in a larger trial of 200, or it may cause side effects that were not obvious at first.

If you have been diagnosed with ALS, your neurologist can discuss whether you might be a candidate for any active trials. Genetic testing (a blood test that identifies which genes are involved in your ALS) can narrow down which trials are relevant to you. You can also search ClinicalTrials.gov directly by entering "ALS" and your location.

The role of genetic testing in understanding your form of ALS

About 10 percent of ALS cases are inherited (familial ALS). The rest appear to happen randomly (sporadic ALS). Genetic testing identifies which gene is involved, if any. This matters because different genes may respond differently to future treatments, and some genes have trials specifically designed for them.

If you carry a mutation in the SOD1 gene, for example, you are a candidate for certain gene therapies in development. If you have a C9orf72 repeat expansion, different trials may be relevant. Even if no specific treatment exists yet for your genetic form, knowing your genetics helps researchers match you to the right studies and helps you understand your prognosis more precisely.

Genetic testing is usually a blood test ordered by your neurologist. It costs money (sometimes covered by insurance, sometimes not), and it takes a few weeks to get results. If you have a family history of ALS, genetic counseling before or after testing can help you understand what the results mean for your relatives.

What "cure" would actually mean, and why it is not here yet

A cure for ALS would need to do one of three things: stop the disease from progressing (halt it at the point of diagnosis), reverse the damage already done (restore dead neurons), or prevent it from starting in the first place (prevent it in people at genetic risk). Current treatments do none of these. They slow progression slightly, which is valuable but not a cure.

The reason is biological. Motor neurons are hard to protect and impossible to replace with current technology. The disease involves multiple mechanisms—genetic mutations, protein misfolding, inflammation, oxidative stress—and different people's ALS may involve different combinations. A single drug that works for everyone is unlikely. A treatment that works for one genetic form may not work for another.

This is why research is moving toward precision medicine: identifying which mechanism is driving each person's disease and targeting that specific mechanism. It is slower and more complex than finding one magic bullet, but it is more likely to work.

How to talk to your neurologist about treatment options

If you have been diagnosed with ALS, your first conversation should cover whether riluzole or edaravone makes sense for you. Both have side effects (riluzole can affect liver function; edaravone requires IV infusions twice a day for two weeks, then a week off, repeating). Your neurologist will weigh the potential benefit against the burden and your overall health.

Ask about genetic testing if you have not had it. Ask whether any clinical trials are recruiting people with your form of ALS. Ask what symptom management looks like as the disease progresses—what breathing support looks like, what feeding support looks like, what the timeline might be. These conversations are hard, but they let you plan and make decisions while you still can.

Bring a list of questions. Bring someone with you if possible. ALS moves fast, and information from your neurologist is the most reliable source you have. Patient organizations like the ALS Association also have resources and can connect you with others living with ALS who can describe what treatments actually feel like day to day.

Frequently Asked Questions

If I start riluzole or edaravone early, could I avoid getting worse?

No. Both drugs slow progression, but they do not stop it. You will still lose function over time. The benefit is that it happens more slowly, giving you more time with abilities you want to keep. How much time depends on the drug, your individual biology, and how early you start.

Are there any natural or alternative treatments that cure ALS?

No treatment—conventional or alternative—has been shown to cure ALS. Some people try supplements or dietary changes, which may help them feel they are doing something, but none have evidence they slow or stop the disease. Always tell your neurologist what you are taking, because some supplements can interfere with prescribed medications.

If I have the genetic form of ALS, am I more likely to benefit from future treatments?

Possibly. Gene therapies in development are designed for specific genetic mutations, so knowing your mutation may open doors to trials that would not be relevant otherwise. But having a genetic form does not may provide a treatment will work for you—it just means researchers have a clearer target.

How long do people usually live after diagnosis?

ALS progresses differently in different people. Some people live two to three years after diagnosis; others live ten or more. Factors include age at diagnosis, which muscles are affected first, and how quickly the disease progresses in the first months. Your neurologist can discuss what the typical timeline looks like, but individual variation is large.

Should I join a clinical trial even if it might not help me?

That is your choice. Trials help researchers test whether new treatments work, which benefits future people with ALS even if you do not benefit directly. Trials also come with risks and burdens—extra appointments, possible side effects, uncertainty about whether you are getting the active drug or a placebo. Discuss the specific trial with your neurologist and the research team before deciding.