• Eva L Feldman, Stephen A Goutman, Susanne Petri, Letizia Mazzini, Masha G Savelieff, Pamela J Shaw, and Gen Sobue.
• Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA. Electronic address: efeldman@umich.edu.
• Lancet. 2022 Oct 15; 400 (10360): 136313801363-1380.

AbstractAmyotrophic lateral sclerosis is a fatal CNS neurodegenerative disease. Despite intensive research, current management of amyotrophic lateral sclerosis remains suboptimal from diagnosis to prognosis. Recognition of the phenotypic heterogeneity of amyotrophic lateral sclerosis, global CNS dysfunction, genetic architecture, and development of novel diagnostic criteria is clarifying the spectrum of clinical presentation and facilitating diagnosis. Insights into the pathophysiology of amyotrophic lateral sclerosis, identification of disease biomarkers and modifiable risks, along with new predictive models, scales, and scoring systems, and a clinical trial pipeline of mechanism-based therapies, are changing the prognostic landscape. Although most recent advances have yet to translate into patient benefit, the idea of amyotrophic lateral sclerosis as a complex syndrome is already having tangible effects in the clinic. This Seminar will outline these insights and discuss the status of the management of amyotrophic lateral sclerosis for the general neurologist, along with future prospects that could improve care and outcomes for patients with amyotrophic lateral sclerosis.Copyright © 2022 Elsevier Ltd. All rights reserved.

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