“Clinical Stabilization in Amyotrophic Lateral Sclerosis Following Riluzole and Edaravone Therapy: A Case Report”

Abstract

Abstract
Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder involving upper and lower motor neurons, usually leading to progressive weakness and respiratory or bulbar dysfunction.
Case Presentation: A 63-year-old woman presented with a 3-year history of progressive, asymmetric weakness that began in the right lower limb and subsequently involved the left lower limb and right upper limb, resulting in triplegia. She later developed dysarthria and progressive dysphagia. Examination revealed marked muscle wasting, fasciculations including tongue fasciculations, predominantly lower motor neuron signs, and preserved sensation without bowel or bladder involvement. Brain and spinal MRI were unremarkable for structural pathology. Nerve conduction studies were normal, while electromyography showed fibrillations and positive sharp waves, supporting a diagnosis of motor neuron disease.
Treatment and Outcome: The patient was treated with riluzole along with nutritional, speech/swallow, physiotherapy, and supportive management. Edaravone was subsequently added. During 12 months of follow-up, there was no further progression from triplegia to quadriplegia, and bulbar symptoms remained stable.
Conclusion: This case highlights the importance of recognizing LMN-predominant ALS, using electromyography and Awaji criteria for early diagnosis, excluding mimics, and initiating disease-modifying and multidisciplinary supportive therapy promptly. Clinical stabilization during follow-up suggests a potentially favorable response to therapy.