Antiglutamate providers Riluzole Riluzole is an antiglutamatergic agent considered to hinder the presynaptic release of glutamate. Predicated on this meta analysis, riluzole treatment with 100 mg daily was considered safe, well tolerated PFT and was associated with a statistically significant improvement in tracheostomy free survival. Because the increase in survival is about 2-3 weeks, the effect size was nevertheless small. Benefits from population based studies indicated that riluzole therapy increased survival rates at extended survival by 4 C6 months and 12 months by about one hundred thousand. One study discovered also a stronger helpful result amongst bulbar onset ALS and people aged 70 years. The favorable effect of the drug was lost and transient in prolonged followup. Research on transgenic mice demonstrated that the debt in glutamate uptake becomes more severe by end stage of the disease and might be the cause for the loss of efficiency of the drug in ALS. More studies are consequently needed, particularly to explain Lymphatic system the results of riluzole in older patients, in bulbar ALS, and in patients with more high level disease. Memantine Memantine is just a low affinity, non-competitive antagonist of both available route N methyl N aspartate and calcium permeable amino 3 hydroxy 5 methyl 4 isoxazole propionic acid glutamate receptors. It permits the blockade of extortionate NMDA receptors action, without disrupting normal synaptic transmission. 13 Various in vitro and in vivo models of excitotoxicity showed that memantine has neuroprotective properties14 and the drug has been used clinically with excellent security in different neurodegenerative conditions, including Alzheimer s illness. Two new animal studies on SOD1 transgenic mice unearthed that the drug is effective in increasing survival and reducing progression of transgenic mice. In a single study, the administration of memantine had healing Doxorubicin Rubex effects, even though given at symptoms on-set. Though one phase II clinical trial in US and mixed phase II CIII clinical trials are ongoing L-arginine is a semi-essential amino acid that acts as sole substrate for enzymes involved in diverse cell processes, Information on ALS patients are lacking. Pre-clinical studies have found that L arginine protects cultured motor neurons from glutamate excitotoxic damage. The mechanism underlying these positive results is still unknown but may be associated with the synthesis of neuroprotective polyamines, needed for neuronal survival and regeneration. L-arginine supplementation in SOD1 transgenic ALS mice, administrated both before and following the onset of motor neuron damage, notably slowed the development of neuropathology in lumbar spinal-cord, delayed onset of motor dysfunction, and prolonged life time. More over, lower lcd L-arginine levels have been noted in ALS patients, probably due to malnutrition related to advanced level ALS.