Intrathecal thyrotropin-releasing hormone in amyotrophic lateral sclerosis

Thyrotropin releasing hormone (TRH) has potential therapeutic applications in amyotrophic lateral sclerosis (ALS) and related diseases because of its function as a neuroregulator of the anterior horn cell. However, its therapeutic potential, and that of other neuropeptides, is reduced by the blood-brain barrier that limits access to neuronal cells. We have thus explored the direct intrathecal administration of TRH in ALS, with both short-term boluses and infusions and chronic constant infusions. Our experience suggests that this approach is safe, has high patient acceptance, and is worthy of more careful evaluation.