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Given the poor prognosis of amyotrophic lateral sclerosis (ALS), guidelines for the diagnosis should clearly be as sensitive and specific as possible. In 2006, a consensus meeting1 at Awaji-Shima, Japan, suggested a modification to the current El Escorial criteria to allow electromyographic evidence of denervation, including fasciculations, to carry equal weight to clinical evidence. In the current issue, Douglass and colleagues2 have compared the sensitivity and specificity of the current El Escorial criteria with these new Awaji-Shima criteria (see page …