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AAN 2022 | Improving ALS diagnosis: the Gold Coast criteria and the role of TMS

Matthew Kiernan, MBBS, PhD, DSc, FRACP, FAHMS, University of Sydney, Sydney, Australia, shares an overview of recent advances in the diagnosis of amyotrophic lateral sclerosis (ALS). Previous diagnostic criteria categorized patients as definite, probable, possible, or suspicious, based on diagnostic certainty. The newly established Gold Coast criteria has eliminated these subsets and instead provided possible outcomes of either ALS or not ALS, to facilitate earlier diagnosis, enable clinical trial participation, and improve inter-rater agreement. The Gold Coast criteria for diagnosis of ALS requires evidence of progressive motor impairment, presence of upper and lower motor dysfunction, and investigations to exclude other disease processes. Prof. Kiernan additionally talks on the diagnostic utility of cortical hyperexcitability assessed by transcranial magnetic stimulation (TMS) in ALS. The presence of cortical hyperexcitability together with a fitting clinical phenotype can support the definitive diagnosis of ALS, and thus, work is ongoing to develop a protocol to make this technique widely accessible. This interview took place at the American Academy of Neurology 2022 Congress in Seattle, WA.