A series of studies with new treatments for amyotrophic lateral sclerosis (ALS) has created a rare mood of optimism in the field of neurology. The new therapeutic approaches have been developed as a result of 3 hypotheses relating to the pathogenesis of ALS. In each case, some signs of treatment success have been seen. An option for the future may be to combine the different approaches with the hope of achieving an additive effect. In the meantime, the studies conducted to date have raised several questions relating to trial design and interpretation, according to experts speaking at the 48th Annual Meeting of the American Academy of Neurology [San Francisco, US; March 1996].