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Paradigm shifts are occurring across the realm of amyotrophic lateral sclerosis (ALS). In the past, we instructed medical students that ALS was solely a clinical diagnosis; that careful clinical examination raised the specter of this devastating condition, and neurophysiologic testing provided confirmation. We taught that ALS was an isolated clinical syndrome; that neuroimaging was not helpful for the diagnosis, other than to exclude mimic syndromes; that patients did not have significant dementia; and finally, that little could be done to predict or alter an individual patient's course.
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