Which Criteria Should Be Used to Diagnose ALS?

For the last 10 years, the revised El Escorial criteria have been the gold standard for the research diagnosis of amyotrophic lateral sclerosis (ALS). These criteria define ALS with four tiers of diagnostic confidence, depending on the extent of upper motor neuron (UMN) and lower motor neuron (LMN) findings. The Awaji criteria, published in 2008, were an effort to improve sensitivity for the diagnosis of ALS. In this algorithm, clinical and electromyographic evidence of LMN dysfunction are given equal weight, and fasciculations are considered equivalent to fibrillation potentials and positive sharp waves as evidence of ongoing denervation. In a prospective study of 215 patients who were evaluated for suspected ALS (200 of whom were eventual…