As non-neurophysiologists we enjoyed this informative review of electromyography (EMG), and benefit enormously from the service provided by our local colleagues. We suggest, however, that EMG is neither ‘essential’ nor ‘diagnostic’ for motor neurone disease (MND). Rather, for at least the 85% of cases with classical amyotrophic lateral sclerosis, MND is a clinical diagnosis.

The average delay in diagnosis of MND from the onset of symptoms has stubbornly remained around 1 year over the last two decades.1 Over-reliance on investigations, including neurophysiology, excluding implausible mimic conditions may be a contributory factor. The first …