According to a commentary, this study challenges the current clinical landscape in amyotrophic lateral sclerosis (ALS), in which prolongation of life at a time of severe, progressive disability might be considered less desirable for patients, their carers, and treating clinicians. It adds that when discussing treatment options, patients and clinicians must also take into account the established absence of motor functional improvement determined through previous riluzole trials. It calls for clarification of the mechanisms of action of riluzole in large prospective trials, surveying all clinical stages of ALS.