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All diagnoses are clinical, but some are more clinical than others
  1. Roger Graham Whittaker
  1. Correspondence to Dr Roger Graham Whittaker, Department of Clinical Neurophysiology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK; Roger.whittaker{at}

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The authors take exception to my assertion that electromyography remains an ‘essential diagnostic test’ in motor neurone disease (MND), instead insisting that for most patients this is a clinical diagnosis. I agree. In fact I would go further; of course all diagnoses are clinical. However, for some diseases diagnostic tests are an essential part of making a clinical diagnosis, and MND is one such example.

Neurophysiology has two roles in the context of suspected MND. First, it is to provide independent evidence in support of the diagnosis. I'd be the first to admit that the electrodiagnostic criteria for MND are far from perfect, and specifically I would agree that the nomenclature is clumsy. Recent refinements have increased …

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