One hundred and eight patients with amyotrophic lateral sclerosis (ALS
) received ceftriaxone 2 g daily i.v. (62) or i.m. (34) or by both rou
tes (12), for 21-day cycles on an open basis, Baseline MRC and Norris
scores were similar to those at the end of the first 21-day cycle of t
herapy, Seven patients showed remarkable clinical improvement, mostly
segmental, which started during the first week of treatment and lasted
up to 2 months after its completion, Improvement was also noted in se
ven out of 21 cases given a subsequent cycle of treatment. Based on th
ese findings, the drug is supposed to act by altering the neurochemica
l transmission at the neuromuscular junction and/or by facilitating th
e presynaptic uptake of glutamate at the synaptic junction, This hypot
hesis positively correlates with the results of in vitro experiments s
howing that ceftriaxone increases H-3-glutamate uptake in rat spinal c
ord synaptosomes.