TY - JOUR T1 - Diagnosing ALS: the Gold Coast criteria and the role of EMG JF - Practical Neurology JO - Pract Neurol DO - 10.1136/practneurol-2021-003256 SP - practneurol-2021-003256 AU - Martin R Turner A2 - , Y1 - 2022/01/06 UR - http://pn.bmj.com/content/early/2022/01/05/practneurol-2021-003256.abstract N2 - 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 1 The Gold Coast criteria for the diagnosis of amyotrophic lateral sclerosisProgressive motor impairment documented by history or repeated clinical assessment, preceded by normal motor function,ANDThe 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,ANDInvestigations§ excluding other disease processes.Increased deep tendon reflexes, including the presence of a reflex in a clinically weak and wasted muscle, or spread to adjacent muscles.Presence of pathological reflexes, including Hoffman sign, Babinski sign, crossed adductor reflex, or snout reflex.Increase in velocity-dependent tone (spasticity).Slowed, poorly coordinated voluntary movement, not attributable to weakness of lower motor neurone origin or Parkinsonian features.Evidence of chronic neurogenic change, defined by large motor unit potentials of increased duration and/or increased amplitude (with polyphasia), and motor unit instability regarded as supportive but not obligatory evidence, andEvidence of ongoing denervation, including fibrillation potentials or positive sharp waves, or fasciculation potentials.*Upper motor neurone dysfunction implies at least one of the following:†Lower motor neurone dysfunction in a given muscle requires either: Clinical examination evidence of muscle weakness and muscle wasting, or EMG abnormalities that must include both:‡Body regions are defined as bulbar, cervical, … ER -