In conclusion, corticosteroids are a class of medications with wide-ranging clinical uses and wellstudied effects on the immune system. ALS progression is associated with changes in immune system function, with the early disease states associated with anti-inflammatory immune markers and the advanced disease states associated with
pro-inflammatory immune markers. Although treatment with corticosteroids may cause a transient change in some immune markers, both preclinical and clinical trials have failed to show any clinical benefit in ALS. Multiple individual PALS
have self-reported improvement in weakness with corticosteroid treatment, but these cases have unclear generalizability and are limited by an uncertain ALS diagnosis, limited clinical data during the disease course, and heterogeneity of glucocorticoid type and dose. Although affordable and widely available, corticosteroids can have numerous side effects, and their risks are greater for higher doses or prolonged treatment. Therefore, we cannot recommend corticosteroids at this time as a way to slow ALS progression. Further research into immune system modulation in ALS is ongoing at many research centers internationally.