Re-evaluation in 6 months to one year.

He was told that there is a question of motor neuron disease (ALS), but progressive course and involvement of other myotomes (besides cervical) are needed to make that diagnosis. Genetic testing for ALS should be considered after genetic counseling , given his age (there was no family history of ALS or neurodegenerative disease).

Patient was lost for follow up, but returned for reevaluation 12 years later. His symptoms had stabilized a year after symptom onset. Neurologic examination had not changed since the prior evaluation: he still had bilateral upper limb weakness, no weakness in the cranial nerves, axial or lower limbs muscles, DTRs were hyperreflexic with bilateral Hoffmann reflex and ankle clonus.

Repeat EMG was done.