New developments in the diagnosis and management of motor neuron disease

Introduction

Motor neuron disease (MND) is a devastating neurodegenerative disease characterized by progressive muscle weakness.

Sources of data

PubMed, MEDLINE, and Cochrane databases were searched for articles to March 2024. Searches involved the terms ‘motor neuron disease’ or ‘amyotrophic lateral sclerosis’ and ‘epidemiology’, ‘diagnosis’, ‘clinical’, ‘genetic’, ‘management’, ‘treatment’, or ‘trial’.

Areas of agreement

Evidence-based management involves riluzole, multidisciplinary care, provision of noninvasive ventilation and gastrostomy, and symptomatic treatments. Tofersen should be offered to treat SOD1-MND.

Areas of controversy

Edaravone and Relyvrio are approved treatments in the USA, but insufficient evidence was found to support approval in the UK and Europe.

Growing points

The discovery of neurofilaments as MND biomarkers, growth of platform trials and development of novel therapies provide optimism for more powerful neuroprotective therapies.

Areas timely for developing research

Further work should focus on the elucidation of environmental causes of MND, gene–environment interactions, and advanced cellular models of disease.