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However, at higher concentrations, ammonia induces significant mitochondrial damage, compromising mitochondrial membrane integrity and promoting the release of cytochrome c and other pro-apoptotic molecules (such as SMAC/DIABLO) into the cytoplasm

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Jette L, Leger R, Thibaudeau K, et al

Glutamate toxicity is highly relevant in ALS since it may favor disease progression via multiple pathways, by directly affecting motor neurons and modulating astrocytic reactive phenotype and their secretome, thus providing paracrine signals to neighbouring cells 14

It sounds like these people kept getting the same injury over and over again over eight weeks or 12 weeks