1). There is no known definitive cause of ALS; familial ALS, a hereditary form of the disease, accounts for 5%–10% of cases (1). No cure has been identified, and the lack of proven and effective therapeutic interventions for ALS is an ongoing challenge. Riluzole (brand name Rilutek) is currently the only drug that has been approved by the Food and Drug Administration (FDA) to treat ALS; however, it only prolongs life by approximately 2–3 months on average (2). In some patients, intraspinal neural stem cell transplantation has been shown to have improved ALS Functional Rating Scale-Revised scores, a standard assessment for ALS (3,4). Clinical trials for ribonucleic acid–targeted therapeutics for genetic variants of ALS also have started (5). Although there is no blood test for ALS, the diagnosis of the disease has evolved. ALS is diagnosed largely on the basis of signs and symptoms as well as neurophysiologic tests, primarily electromyograms.
ALS affects persons of all races and ethnicities. Several potential risk factors for ALS have been identified. Whites, males, non-Hispanics, those aged >60 years, and those with a family history of the disease are more likely to develop ALS (1,6). Previous exposure to heavy metals (e.g., lead and chromium), pesticides, and β-N-methylamino-L-alanine (BMAA) produced by cyanobacteria also have been associated with an increased risk for ALS (7–11). Military service continues to be a possible risk factor for ALS; however, no strong evidence has been found linking etiology with service (12–15). Other possible risk factors such as nutritional intake, use of statins, exposure to viral agents, vigorous physical activity, and trauma also have been identified as possible risk factors (12,16–21).
ALS is a bad disease, but you know, I've never seen a case, maybe because it is most common in white males, and I spent most of my medical career with rural white/rural Hispanic or Native American patients in the US, or with Bantu Africans in Africa.
the big question: are we seeing more cases, or are we just finding/diagnosing more cases?
another big question: Is it more common in those who have had military service?
much of the article is technical, on how they are trying to analyze how common and in whom we see the disease.