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ALS is mostly diagnosed based on clinical signs, using the revised El Escorial criteria, which require signs of both upper motor neuron (e.g., spasticity, brisk reflexes) and lower motor neuron damage (e.g., muscle wasting, twitching) in multiple body regions (Brotman et al., 2025)

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doi: 10.1016/j.omto.2017.05.005 108 PawlikTMNakamuraHMullenJTKasuyaHYoonSSChandrasekharSet al

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As we age, our natural levels of acetyl-carnitine decrease, leading to slower metabolism and reduced energy levels