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[Epidemiology, clinical spectrum of ALS and differential diagnoses].
[inclusion body myositis]
Amyotrophic
Lateral
Sclerosis
(
ALS
)
is
the
most
common
motor
neuron
disease
in
adults
.
Its
incidence
in
France
is
estimated
at
2
.
5
per
100
,
000
population
and
its
prevalence
between
5
and
8
per
100
,
000
inhabitants
.
Good
prognostic
factors
are
age
of
early
onset
,
a
longer
time
to
diagnosis
,
initial
damage
to
the
spinal
onset
,
early
management
of
undernutrition
and
restrictive
respiratory
failure
.
The
diagnosis
of
ALS
is
primarily
clinical
and
is
based
on
the
evidence
of
involvement
of
the
central
motor
neuron
and
peripheral
neuron
(
NMP
)
in
different
territories
or
spinal
or
bulbar
.
The
EMG
confirms
the
achievement
of
NMP
,
shows
the
extension
to
clinically
preserved
areas
and
allows
to
exclude
some
differential
diagnoses
.
The
clinical
spectrum
of
ALS
is
broad
:
conventional
forms
beginning
brachial
,
lower
limb
or
bulbar
onsets
,
rarer
forms
to
start
breathing
,
pyramidal
forms
,
forms
with
cognitive
and
behavioural
impairment
.
In
5
-
10
%
of
cases
,
ALS
is
familial
.
In
15
%
of
cases
,
it
is
associated
with
frontotemporal
degeneration
rather
than
orbito-
frontal
type
.
The
main
differential
diagnoses
are
guided
by
the
clinic
:
combining
pure
motor
neuropathy
with
or
without
conduction
block
,
post-polio
syndrome
,
cramp-
fasciculation
syndrome
,
myasthenia
gravis
,
paraneoplastic
syndromes
,
Sjögren
syndrome
,
retroviral
infections
,
some
endocrine
disorders
,
some
metabolic
diseases
,
genetic
diseases
(
Kennedy
and
SMA
)
and
inclusion
body
myositis
.
Diseases
Validation
Diseases presenting
"bulbar onsets"
symptom
inclusion body myositis
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