ABSTRACT
ALS, once thought to be an untreatable disease, has emerged as a model highlighting the significant impact that supportive and adjunctive therapies have on the disease course. ALS results in a large constellation of disabling bulbar and constitutional symptoms for which there is effective therapy. Unfortunately, there are few randomized, controlled trials of medications or interventions addressing symptom management. As a result, physicians caring for ALS patients base their selection of specific therapies upon personal experience and anecdotal reports from colleagues and patients. While this ‘‘on the job’’ training is helpful, the lack of scientific data to guide therapy has led to a wide variety of management practices (1).
