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The onset of amyotrophic lateral sclerosis
  1. M de Carvalho1,
  2. M Swash2
  1. 1Department of Neurology, Neuromuscular Unit, Santa Maria Hospital, Lisbon and EMG Laboratory, Centro de Estudos Egas Moniz, Institute of Molecular Medicine, University of Lisbon, Portugal
  2. 2Institute of Neuroscience, Barts and The London NHS Trust, Department of Neurology, Royal London Hospital, Queen Mary University of London, London, UK
  1. Correspondence to:
 Dr M de Carvalho
 Department of Neurology, Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649 Lisbon, Portugal; mamedemg{at}


Two patients in whom both the neurological examination and electromyography (EMG) were normal prior to the onset of amyotrophic lateral sclerosis (ALS) are reported. In each patient, the onset of ALS some 18 months later was clearly defined clinically and confirmed by subsequent EMG studies. These unique observations show that ALS commences at a defined time, and that there is early generalisation with an initial phase of rapid progression.

  • electromyography
  • motor neuron disease
  • amyotrophic lateral sclerosis
  • disease onset
  • progression

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  • Competing interests: there are no competing interests