<unk>  is a diagnosis of exclusion, there is no specific test which can conclusively establish whether a patient has the condition. Instead, a number of other possibilities have to be ruled out, such as multifocal motor neuropathy or spinal<unk><unk> . Tests used in the diagnostic process include MRI, clinical examination, and EMG. EMG tests in patients who do have<unk>  usually show denervation (neuron death) in most affected body parts, and in some unaffected parts too. It typically takes longer to be diagnosed with<unk>  than ALS, an average of 20 months for<unk>  vs 15 months in ALS. Differential diagnosis In contrast to amyotrophic lateral sclerosis or primary lateral sclerosis,<unk>  is distinguished by the absence of: * brisk reflexes * spasticity * Babinski's sign * emotional lability The importance of correctly recognizing<unk>  as opposed to ALS is important for several reasons. * The prognosis is a little better. A recent study found the 5-year survival rate in<unk>  to be 33% (vs 20% in ALS) and the 10-year survival rate to be 12% (vs 6% in ALS). * Patients with<unk>  do not suffer from the cognitive change identified in certain groups of patients with MND. * Because<unk>  patients do not have UMN signs, they usually do not meet the World Federation of Neurology El Escorial Research Criteria for "Definite" or "Probable" ALS and so are ineligible to participate in the majority of clinical trials conducted in ALS. * Because of its rarity (even compared to ALS) and confusion about the condition, some insurance policies or local healthcare policies may not recognize<unk>  as being the life-changing illness that it is. In cases where being classified as being<unk>  rather than ALS is likely to restrict access to services, it may be preferable to be diagnosed as "slowly<unk>  ALS" or "lower motor neuron predominant" ALS. An initial diagnosis of<unk>  could turn out to be slowly<unk>  ALS many years later, sometimes even decades after the initial diagnosis. The occurrence of upper motor neuron symptoms such as brisk reflexes, spasticity, or a Babinski sign would indicate a progression to ALS; the correct diagnosis is also occasionally made on autopsy.
Progressive muscular atrophy
Progressive bulbar palsy
Lipodystrophy
Multifocal motor neuropathy
Cerebral atrophy
Osteodystrophy
Facial onset sensory and motor neuropathy
Progressive inflammatory neuropathy