Highlights
- •We recorded the functional evolution in patients with definite sporadic ALS.
- •Patients included received dual treatment with lithium carbonate and valproate.
- •Survival in patients under the co-treatment was significantly increased.
- •Antioxidant defenses were improved and correlated with lithium levels.
- •Later adverse effects were the main cause of dropping out from the study.
Abstract
The aim of this study was to evaluate the ability of lithium carbonate and valproate
cotreatment to modify the survival rate and functional score of patients with definite
sporadic amyotrophic lateral sclerosis (ALS). The clinical response of 18 enrolled
patients was compared to the evolution of 31 ALS out-patients, carefully paired by
age, gender, evolution rate and time of the disease, who never received treatment
with lithium and/or valproate. The ALS functional rating scale, revised version (ALSFRS-R),
was applied at baseline, 1 month, and every 4 months until the outcome (death or an adverse event). Biochemical markers, such as
Cu/Zn superoxide dismutase and glutathione peroxidase activity, and reduced glutathione
were assayed in plasma samples obtained at the baseline visit and after 5 and 9 months of treatment. Our results showed that lithium and valproate cotreatment significantly
increased survival (p = 0.016), and this treatment also exerted neuroprotection in our patients because all
three markers reached levels that were not significantly different from the matched
samples of healthy donors. The trial stopped after 21 months, when the sample was reduced to under two-thirds, due to the late adverse events
of the treatment. The results call for large randomized clinical trials with the dual
association, but at low doses to avoid adverse events.
Keywords
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Article info
Publication history
Published online: March 25, 2014
Accepted:
March 3,
2014
Received in revised form:
February 12,
2014
Received:
October 1,
2013
Identification
Copyright
© 2014 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
