RANJAN

Hello Mr. Roberts,

The May 29th visit would be a routine clinic follow up visit to see how you are doing and address any new issues that you maybe facing. You will be seen by our ALS team, i.e. the physical therapist, nutritionist, nurse co-coordinator and us (Dr. Mitsumoto and I).

As for the lithium study, this was published in February 2008 and indeed created a lot of excitement in the ALS circles. While the study results were rather dramatic, the study design itself was somewhat unclear. Since then, many patients have gone on Lithium and multiple centers have run small studies to see how patients tolerate the medication. The general feeling (and this is not a controlled study result!) amongst patients and physicians is that Lithium is not an easy medication to take and has not shown any dramatic change in patients who have been on the drug for many months.

There are two major trials ongoing in the US as well as multiple other trials in Europe to attempt to answer the question of whether this drug really is effective in slowing the progression of ALS. None of these trials are completed as yet so we don't know the results.

I hope that answers your question.

Look forward to seeing you in the end of May.

Sincerely,

Ali A Ranhan, MD