Swash, MichaelBurke, DavidTurner, Martin R.Grosskreutz, JulianLeigh, P. NigelCarvalho, MamedeKiernan, Matthew C.2021-12-102021-12-102020Journal of neurology, neurosurgery, and psychiatry, 91(3), 227–2340022-3050http://hdl.handle.net/10451/50335© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.The diagnosis of amyotrophic lateral sclerosis (ALS) requires recognition of both lower motor neuron (LMN) and upper motor neuron (UMN) dysfunction. However, classical UMN signs are frequently difficult to identify in ALS. LMN involvement is sensitively detected by electromyography (EMG), but, as yet, there are no generally accepted markers for monitoring UMN abnormalities, the neurobiology of ALS itself and disease spread through the brain and the spinal cord.engjournal article10.1136/jnnp-2019-3219381468-330X