Diagnosing ALS: the Gold Coast criteria and the role of EMG

In September 2019, a group of international neurologists gathered in Gold Coast, Australia, to deconstruct the diagnostic process for amyotrophic lateral sclerosis (ALS) and to try to simplify it. A proposal for revised diagnostic criteria emerged1 (box 1) and the initial experience of their application has been positive.2–5 The diagnosis remains fundamentally clinical, and it is timely to reflect on the adjunctive role of electromyography (EMG).

Box 1The Gold Coast criteria for the diagnosis of amyotrophic lateral sclerosis

  • Progressive motor impairment documented by history or repeated clinical assessment, preceded by normal motor function,

  • AND

  • The presence of upper* and lower motor neurone dysfunction in at least ONE body region, with:

  • upper and lower motor neurone dysfunction noted in the same body region if only one region is involved,

  • or lower motor neurone dysfunction in at least TWO body regions,

  • AND

  • Investigations§…

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