Adrenomyeloneuropathy (AMN) is the form ALD takes in adult life. It does not progress abruptly like cerebral disease; the spinal cord is damaged slowly, over years.
Most men carrying an ABCD1 variant eventually follow this course. Women develop the same pattern of spinal cord symptoms as they get older.
What it is
Where cerebral ALD is an inflammatory process that switches on, AMN is closer to a slow degeneration of spinal cord axons. The two differ in mechanism, which is why treatment that works for cerebral disease does not transfer to AMN.
Onset is usually between the twenties and forties, with wide individual variation. The rate of progression varies as well.
Symptoms
These arise from damage to the long tracts of the spinal cord.
Motor
- Walking is not what it was — difficulty with distance, with stairs
- Spasticity in the legs, usually roughly symmetrical
- Falls, difficulty with balance
- With progression, walking aids may become necessary
Sensory
- Numbness or tingling beginning in the feet
- Loss of position sense — particularly unsteadying in the dark
Bladder and bowel
- Urgency, frequency, incomplete emptying
- Constipation
Other
- Pain
- Sexual dysfunction
- Fatigue
Adrenal insufficiency is frequently present, and may precede the neurological symptoms. → Adrenal Insufficiency
Diagnosis
Confirmed by plasma very long chain fatty acids and ABCD1 genetic testing.
The difficulty is that diagnosis is often long delayed. Because onset is gradual and the picture resembles commoner conditions, patients are frequently given another diagnosis first:
- Multiple sclerosis
- Lumbar or cervical disc disease
- Hereditary spastic paraplegia
- Myelopathy of unknown cause
The 2022 international consensus recommendations advise considering ALD in adult men and women with signs of chronic myelopathy and a normal brain MRI, and in boys and men with primary adrenal insufficiency of no other established cause.
Where there is ALD in the family, sharing that at the consultation changes the diagnostic pathway substantially.
Cerebral conversion has to be watched for
This is the most important part of this page.
Men with AMN can convert to cerebral disease. Cerebral disease can be halted if caught early and cannot be treated once advanced.
International recommendations therefore call for all boys and men to undergo cerebral surveillance with brain MRI regardless of symptoms. For adult men, surveillance continues for as long as transplantation remains a therapeutic option.
Stable AMN is not a reason to stop imaging. Stopping means missing the thing that can actually be acted on.
Routine cerebral surveillance is not recommended for girls and women.
Treatment and care
There is no established treatment that halts AMN. That is not the same as there being nothing to do.
Symptom management
International recommendations set the aim as reducing pain and spasticity and maintaining function and quality of life.
- Pain — neuropathic agents such as pregabalin or gabapentin
- Spasticity — spasmolytics such as baclofen
- Bladder — continence care
- Rehabilitation — referral to a rehabilitation specialist may be considered alongside routine neurological care
Maintaining walking capacity and muscle strength translates directly into quality of life.
Follow-up
Yearly follow-up is recommended for men and women with myeloneuropathy. For men, this sits alongside brain MRI for cerebral surveillance and adrenal function testing.
Leriglitazone
In ADVANCE — a 96-week randomised, double-blind, placebo-controlled phase 2–3 trial in adult men with AMN (Lancet Neurology, 2023) — the primary endpoint, change in six-minute walk distance at week 96, was not met.
Several secondary observations were reported:
- Clinically relevant differences in body sway
- Favourable trends in EDSS, SSPROM and quality of life
- Cerebral ALD occurred only in the placebo group
That last finding led to the paediatric cerebral programme and, in 2026, to a positive regulatory opinion in Europe. The recommended indication is limited to boys aged 2–12 with cerebral disease; adult AMN is not included.
A separate phase 3 trial, CALYX, is running in adults with cerebral disease. → Treatment
Transplantation does not apply here
Haematopoietic cell transplantation is unlikely to affect myeloneuropathy, as stated in the international recommendations. It is a treatment for cerebral disease, not for AMN itself.
Course
AMN progresses slowly, over years to decades, with wide variation between individuals. It does not deteriorate abruptly in the way cerebral disease does.
The number of things requiring management grows over time, and that management makes a real difference.
One further point: severe head trauma has been reported as a possible trigger for cerebral disease. The causal relationship is not established, but international recommendations advise counselling male patients so that they can make their own decisions about how they live.
Based on the 2022 international consensus recommendations (Neurology) and published research. Sources are indicated in the text.
Last reviewed: 7 August 2026
This page provides general medical information and does not replace care for an individual patient.