Amyotrophic Lateral Sclerosis Clinical Trial
Official title:
Acetylcholine Receptors From Human Muscles as Pharmacological Target for ALS
Amyotrophic lateral sclerosis (ALS) is a fatal disease leading to motor neuron degeneration and progressive paralysis. Other studies have revealed defects in skeletal muscle even in absence of motor neuron anomalies, focusing on acetylcholine receptors (AChRs) and supporting the so-called "dying-back" hypothesis. Outcome of this study will be to understand if the endocannabinoid palmitoylethanolamide (PEA) can reduce the rundown of AChRs currents in ALS muscle, and if it can modify ALS patients' clinical and electrophysiological parameters.
Outcome:
Monitoring the efficacy and safety of PEA in the treatment of patients with ALS. Analysis of
AChR currents and description of the composition of AChRs subunits in ALS muscles
Design of the Study:
A randomized controlled blinded study. Patients with sporadic ALS will receive riluzole alone
or riluzole+PEA in order to investigate the clinical and electrophysiological effects of
treatment. The expected number of enrolled patients will be 50.
All patients satisfying the selection criteria will be randomized into two groups: a first
group will be treated only with riluzole, the second group with riluzole associated with PEA
(Normast 600 mg microgranular, 2 sachets/day). The randomization will be done stratifying
patietns according to type of clinical onset (bulbar vs. spinal). The patients will be
enrolled in the Department of Neurology and Psychiatry, University of Rome "Sapienza".
The visits will be performed at 0 (randomization), 3 and 6 months. At each visit the ALS
Functional Rating Scale-Revised (ALSFRS-R), the percentage of predicted forced vital capacity
(FVC%), the Medical Research Council (MRC) score for muscle strength limited to the right
upper limbs, and the compound muscle action potentials (CMAP) from right ulnar and phrenic
nerves will be assessed. A muscle biopsy will be done at the end of the study. The obtained
results will be compared with those observed in muscle samples from denervated (non-ALS)
control patients.
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