The Syndromic Nature of Amyotrophic Lateral Sclerosis

Abstract

Let me start with a confession, I do not believe in amyotrophic lateral sclerosis. This used to bother me, but now I recognize this disbelief as an advance and an advantage. It is an advance because it explains things previously unexplainable like the clinical variations in presentation, duration, and severity of the disorder, the occasional remissions and improvements and the unusual cases that are due to a definite cause. It is an advantage because it enables me to initiate a detailed evaluation of each patient, with a clear conscience that I am not wasting time or money and with reasonable expectation of success. I conduct the investigation as if the patient’s life depended on the outcome, as it often does. My motto is to spend as much time and money evaluating each patient with ALS as I would have spent if that patient had cancer or leukemia or some other usually serious and often fatal condition.