The role of cytokines in the pathophysiology of amyotrophic lateral sclerosis (ALS) and its relation to clinical outcome has not been clearly defined. We evaluated tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma) and nitric oxide (NO) levels in the serum of 22 ALS patients and 20 controls. Serum TNF-alpha levels and IFN-gamma levels were significantly (P < 0.001) elevated in ALS patients. We also observed NO levels to be significantly (P < 0.05) increased with respect to normal subjects. We further noticed positive correlation between the duration of ALS and these proinflammatory molecule levels. Exitotoxicity and oxidative stress are known to play a crucial role in the neurodegeneration observed in ALS. Since high levels of TNF-alpha are known to be cytotoxic, it could be that a complex interplay of these effectors may be one of the factors underlying the progression of ALS. This study confirms the involvement of inflammation in ALS and the need to develop surrogate markers to check the progression of this disease.