ALSUntangled #66: antimycobacterial antibiotics.

Area of Science:

• Neurology
• Infectious Diseases
• Microbiology

Background:

• Motor neuron diseases, including amyotrophic lateral sclerosis (ALS), have been linked to various infectious agents.
• Mycobacterium avium subspecies paratuberculosis (MAP) is a potential infectious agent implicated in motor neuron disease, with prior case reports suggesting a link to ALS-like symptoms.

Purpose of the Study:

• To explore the potential role of Mycobacterium avium subspecies paratuberculosis (MAP) in the etiology of motor neuron diseases.
• To propose diagnostic considerations for patients presenting with atypical features suggestive of ALS.

Main Methods:

• Review of existing literature on infectious causes of motor neuron disease.
• Analysis of two case reports detailing successful treatment of ALS-like symptoms with antimycobacterial antibiotics.
• Recommendation for diagnostic imaging and further testing in specific patient populations.

Main Results:

• Two case reports showed improvement in ALS-like symptoms following antimycobacterial antibiotic treatment.
• Atypical features in these cases included pain, fevers, and abnormal eye movements.
• The findings suggest a potential, though unconfirmed, association between MAP and motor neuron disease.

Conclusions:

• Chest imaging is recommended for patients with Parkinsonism-ALS (PALS) exhibiting atypical symptoms.
• Abnormal chest imaging may prompt further investigation for mycobacterial infections.
• More evidence is needed to establish a definitive link between mycobacteria and ALS before widespread antibiotic use is endorsed.