Thyrotropin releasing hormone (TRH) has potential therapeutic applications in 
amyotrophic lateral sclerosis (ALS) and related diseases because of its function 
as a neuroregulator of the anterior horn cell. However, its therapeutic 
potential, and that of other neuropeptides, is reduced by the blood-brain 
barrier that limits access to neuronal cells. We have thus explored the direct 
intrathecal administration of TRH in ALS, with both short-term boluses and 
infusions and chronic constant infusions. Our experience suggests that this 
approach is safe, has high patient acceptance, and is worthy of more careful 
evaluation.