***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We performed a 3-month , double-blind , placebo-controlled trial of 300 mg of gangliosides ( Cronassial ) in 40 out patients with amyotrophic lateral sclerosis ( ALS ) . We evaluated drug effect through physical examinations and symptom scales . Though this dosage had no major toxic effect , Cronassial treatment did not significantly benefit ALS patients Two double-blinded , placebo-controlled clinical trials of riluzole have now been carried out in more than 1,100 patients with ALS . The results of both studies show a modest benefit in prolonging survival that is statistically significant . These results led to the availability of this drug by the Food and Drug Administration for use in the United States beginning in early 1996 . This is the first drug that has been available for ALS . It begins a new era in both basic and clinical research in an attempt to find a cure for this disease . NEUROLOGY 1996;47(Suppl 2 ) : BACKGROUND In an attempt to better underst and and define the progression of amyotrophic lateral sclerosis ( ALS ) , we developed a classification of 5 discrete health states that reflect patients ' activities of daily living . These health states were used to determine whether patients with ALS who are treated with riluzole  differed from those treated with placebo . SETTING Clinics for patients with ALS . DESIGN Placebo-controlled trial of riluzole treatment in 959 patients with ALS . INTERVENTIONS Treatment with riluzole or placebo . MAIN DEPENDENT MEASURES : A Cox model was used to assess whether , from the initial r and omization to the end of an 18-month follow-up , there was a difference in the times of transition into subsequent health states between patients treated with riluzole and those treated with placebo . RESULTS Our analysis showed a significant difference in the time to transit between the riluzole and the placebo groups in less severely affected cases , ie , state 2 and state A ( the milder states ) of ALS . CONCLUSION Patients receiving riluzole  remained in the milder health states longer ( P<.05 ) A population of 31 patients with sporadic amyotrophic lateral sclerosis ( ALS ) was selected for a prospect i ve open study based on treatment with riluzole . A neurophysiological evaluation was performed by means of single and paired transcranial magnetic stimulation ( TMS ) . The examined parameters , excitability threshold , motor evoked potential ( MEP ) duration , silent period ( SP ) duration and time course of intracortical inhibition to  paired TMS  after 6 months treatment , were matched against those recorded from the patients themselves before the beginning of treatment and from 20 ( single TMS )  or 10  ( paired TMS ) age-matched control subjects . Normal behaviour of the SP in response to increasing TMS was found in the treated patients ; they showed a significant linear correlation between these two parameters ( r=0.96 ) comparable to that calculated for controls ( r=0.98 ) , and significantly different with respect to drug-free patients ( r=0.8 , P=0.014 ) . A significant reduced size of the ' conditioned ' MEPs to paired stimulation was documented in the treated patients compared with the untreated patients ( P=0.002 ) . Our neurophysiological contribution to the assessment of the effect of riluzole on the motor cortical inhibitory property in ALS may be considered a setting for controlled trials in extended patient series , even in a pre- clinical phase RILUZOLE , a glutamate antagonist , has been shown to be efficacious in the treatment of patients with amyotrophic lateral sclerosis ( ALS ) , allowing prolonged survival and time to tracheostomy . The efficacy of riluzole in thought to result from reduced glutamate excitotoxicity on motor neurons of patients with ALS , but this has never been demonstrated directly in vivo . N-acetylaspartate ( NAA ) , a compound that is readily measured in vivo using proton magnetic resonance spectroscopy , can be used as a surrogate marker for neuronal loss or sublethal injury . To determine whether riluzole reverses sublethal corticomotoneuron damage in patients with ALS we measured NAA/creatine ( Cr ) relative intensity ratios in the motor cortex before and after treatment with riluzole 50 mg bid . After 3 weeks of  riluzole therapy in 11 patients  NAA/Cr increased from 2.14 ± 0.26 to 2.27 ± 0.24 ( p = 0.044 ) , whereas , in 12 untreated patients  NAA/Cr decreased from 2.17 ± 0.20 to 2.08 ± 0.20 ( p = 0.099 ) . Thus the change in NAA/Cr between the treated and untreated groups was 0.22 ± 0.095 ( p = 0.008 ) . The magnitude of increase in NAA/Cr in those treated was not correlated with age , sex , duration of treatment or disease , the presence of probable or definite upper motor neuron ( UMN ) signs , bulbar features , or pre-treatment NAA/Cr . We conclude that magnetic resonance spectroscopy can provide a novel surrogate measure of neuronal integrity that demonstrates reversal of sublethal UMN injury in patients with ALS within weeks of initiating riluzole therapy 
    Output:
    
There was a small beneficial effect on both bulbar and limb function , but not on muscle strength .
REVIEW ER 'S CONCLUSIONS Riluzole 100 mg daily is reasonably safe and probably prolongs survival by about two months in patients with amyotrophic lateral sclerosis .