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Amyotrophic Lateral Sclerosis: Diagnosis

Medically reviewed by Sandeep Dhanyamraju
Medically reviewed by Sandeep Dhanyamraju

Amyotrophic lateral sclerosis is a disease characterized by damage and death of cells in the brain, spinal cord responsible for muscle movement. As a result, muscle weakness and paralysis (lack of movement) develop. The manifestations of the disease are gradually increasing. Patients lose the ability to move independently, the activity of muscles, which are necessary for breathing, is disrupted, which leads to the death of patients.

The reasons for obtaining an ALS are not fully understood. There are several factors that, according to researchers, affect the onset of the disease. These include genetic mutations (changes in genetic material), imbalances of certain chemicals in the nervous system, disorders in the immune system (the system that protects the body from various infections), and others.

The disease is incurable. Taking drugs can slow down the development of amyotrophic lateral sclerosis.


The main manifestations of amyotrophic sclerosis in the early stages of ALS diagnosis include:

  • weakness in the muscles of the arms or legs; decrease in muscle strength can begin in the foot, hand, fingers, and then spread to other muscles of the limbs, trunk
  • slurred speech
  • nasal speech sound
  • difficulty swallowing food
  • twitching in the muscles of the arms, legs, tongue


Over time, muscle weakness builds up, resulting in obtaining an ALS. In the later stages of the disease, the following manifestations occur:

  • loss of ability to stand, walk
  • lack of movement in the arms and legs
  • loss of the ability to chew, swallow food
  • pronounced speech difficulties
  • loss of the ability to breathe spontaneously


ALS Diagnosis

ALS diagnosis

ALS diagnosis is quite difficult, as it is necessary to exclude diseases that can cause similar symptoms. These include damage to the nervous system associated with exposure to heavy metals (for example, lead), infectious diseases, and others.

Laboratory ALS diagnosis plays an important role. Tests are carried out that reflect the general condition of the patient’s blood, indicators of the activity of the liver, kidneys. If abnormalities are detected, additional research may be required.

  • General blood analysis. Allows you to determine the main indicators of blood, the number of erythrocytes, hemoglobin, leukocytes, platelets. An increase in the number of leukocytes is observed in various inflammatory processes.
  • Total whey protein. A certain level of protein is required for the body to function properly. Proteins perform essential functions, carry out the transport of various substances in the body, ensure the retention of fluid in the bloodstream (colloidal-osmotic balance), and are an essential component of several body structures. When obtaining an ALS, eating difficulties arise. As a result, the level of total protein in the blood can be lowered.
  • Alanine aminotransferase. An enzyme that is found in large quantities in liver cells. With the destruction of liver cells, the concentration of alanine aminotransferase in the blood increases. This analysis shows the severity of liver damage.
  • Serum creatinine. Creatinine is produced in muscles during various energy processes and then released into the blood. It is excreted from the body by the kidneys; in several conditions accompanied by impaired renal function, the concentration of creatinine increases. The indicator is essential for assessing kidney function.
  • Whey urea. Urea is the end product of protein metabolism in the body. It is excreted from the body by the kidneys. With kidney damage, impairment of their function, the level of urea increases.


Depending on the clinical situation, the following tests may be required:

  • Determination of the concentration of heavy metals in the blood. Exposure to heavy metals in the human body can damage the nervous system. However, some of the manifestations may be similar to obtaining an ALS (for example, with lead exposure).
  • Determination of the presence of heavy metals in urine. Heavy metals can damage the nervous system (e.g., lead, aluminum).
  • Determination of antibodies to pathogens of infectious diseases. Antibodies are protein particles produced by the body’s immune system in response to the penetration of infection into the human body. Some infectious diseases (such as syphilis) can damage the nervous system.



  • Electromyography. This ALS diagnosis method allows you to assess the electrical impulses that travel along the nerves to the muscles. To do this, special electrodes are applied to the muscle under study. The study is carried out in a calm state and with muscle contraction.
  • Magnetic resonance imaging (MRI). An ALS diagnosis method based on the effect of a magnetic field on the human body. After processing the received signals, layer-by-layer images of the internal structures of the body are obtained. Allows exclusion of the presence of masses (for example, tumors) of the brain and spinal cord.
  • Muscle biopsy. It can be performed if there is a suspicion of a disease in which muscles are affected, and not nerve cells, as in amyotrophic lateral sclerosis. For this, a small piece of muscle is taken, which is then examined in the laboratory.


How is ALS Diagnosis Made?

Amyotrophic lateral sclerosis is extremely difficult to diagnose for several reasons:

  • It is a rare disease.
  • Early symptoms are mild, such as clumsiness, awkwardness in the hands, or mildly plagued speech, all of which may be due to completely different causes.
  • The disease affects each person differently; there is no specific symptom that clearly defines ALS.


If the therapist suspects that the patient is obtaining an ALS, they should refer them to a neurologist. Then the person may have to undergo a series of diagnostic examinations, which can be carried out both on an outpatient basis and in a hospital.

  • Blood test. Research and ALS diagnosis will show whether the level of creatine kinase is elevated in the blood. This enzyme is produced when muscle tissue breaks down, and levels may be elevated in people with ALS. But this indicator is not a specific ALS sign since it can be an indicator of other diseases.
  • Electroneuromyography. ENMG uses fine needles to record nerve impulses in individual muscles. The recording is usually done from each limb and bulbar (pharyngeal) muscles. Muscles that have lost their innervation are detected because their electrical activity is different from that of healthy muscles. ENMG results may differ from normal, even if the specific muscle is not already affected by the disease. With ENMG, the speed of the impulse along the nerve fibers is also checked. To do this, an electrical impulse is passed through a small pad in contact with the skin; this is a crucial research method for diagnostics.
  • Transcranial magnetic stimulation. This is a new method that can be performed simultaneously with ENMG. It is designed to assess the state of motor neurons in the brain. TMS results can help with ALS diagnosis.
  • Magnetic resonance imaging. MRI can detect damage in the nervous system caused by stroke, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, tumors, spinal cord injuries, and brain injuries. MRI does not reveal specific changes in ALS since the damage caused by this disease is not reflected in the images. This research method is used to rule out diseases with ALS-like symptoms.

The neurologist may decide to do additional tests, such as a lumbar puncture or muscle biopsy, if something indicates necessary. But these tests are not always used to diagnose ALS.

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Lone Star Neurology
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Edward Medina
Edward Medina
15:34 30 Jun 22
Just such an amazing staff that makes you feel like part of their family. I’ve been going there for over 5 years now... and each visit I get the very best care and treatments that I have ever received in the 20+ years that I’ve been dealing with severe debilitating migraines. Since i started seeing them the number of my migraines has dropped from 15-20 a month to 2-3 every 3 month. I highly recommend them …they will change your life!read more
Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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