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Esclerose lateral amiotrófica

Última revisão: 12 Sep 2025
Última atualização: 27 Sep 2024

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • presença de fatores de risco
  • fraqueza dos membros superiores
  • rigidez, com comprometimento de coordenação e equilíbrio
  • marcha espástica instável
  • espasmos musculares dolorosos
  • dificuldades para se levantar de cadeiras e subir escadas
  • pé caído
  • rigidez e diminuição do equilíbrio com impacto na marcha
  • cabeça caída
  • dificuldades progressivas de manter a postura ortostática, ao se inclinar
  • atrofia muscular
  • aumento da lordose lombar e tendência de protuberância abdominal
  • hiper-reflexia
  • dispneia
  • tosse e sufocamento com líquidos (incluindo secreções) e eventualmente com alimentos
  • fala lenta e comprimida
  • fala indistinta, nasal e, às vezes, disfônica
  • fala hipofônica
Detalhes completos

Outros fatores diagnósticos

  • propensão a quedas
  • sialorreia
  • crises inadequadas de choro ou riso
  • comprometimento cognitivo
  • características da demência frontotemporal
Detalhes completos

Fatores de risco

  • predisposição genética ou história familiar
  • idade >40 anos
  • serviço militar
  • atividade atlética profissional
  • tabagismo
  • exposição a substâncias químicas agrícolas
  • exposição ao chumbo
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • diagnóstico clínico
Detalhes completos

Investigações a serem consideradas

  • eletromiografia (EMG) e estudos da condução nervosa
  • estimulação nervosa repetitiva
  • ressonância nuclear magnética (RNM) cranioencefálica e da coluna
  • anticorpos anti-GM1
  • anticorpos contra o canal de cálcio dependente de voltagem
  • anticorpos antirreceptor da acetilcolina (AChR) e antitirosina quinase músculo-específica (MuSK)
  • vitamina B₁₂
  • creatina quinase
  • punção lombar
  • teste de HIV
  • teste genético
Detalhes completos

Algoritmo de tratamento

CONTÍNUA

todos os pacientes

Colaboradores

Autores

Christen Shoesmith, MD, FRCPC

Associate Professor of Neurology

Clinical Neurological Sciences

London Health Sciences Centre

London

Ontario

Canada

Declarações

CS has received honoraria from Mitsubishi Tanabe Pharma Canada for participating in scientific medical advisory boards and for presenting at ALS CME events. She has also received stipends for consultancy work for Biogen. She is the chair of the CALS (Canadian ALS Research Network) and in that capacity sits on the scientific medical advisory board for ALS Canada. She is the site PI for several multi-centre clinical trials, including trials sponsored by Mitsubishi Tanabe, AL-S Pharma, Sanofi, Calico, and Cytokintetics. CS is an author of references cited in this topic.

Agradecimentos

Dr Christen Shoesmith would like to gratefully acknowledge Professor Christopher J. McDermott, Dr Laura Simionescu, and Dr Jeremy Shefner, previous contributors to this topic.

Declarações

CJM received fees for membership of data monitoring committees from Orion Pharma and Orphazyme. LS and JS declare that they have no competing interests.

Revisores

William S. David, MD, PhD

Associate Professor of Neurology

Harvard Medical School

Boston

MA

Declarações

WSD declares that he has no competing interests.

Leo McCluskey, MD MBE

Associate Professor of Neurology

University of Pennsylvania

Philadelphia

PA

Disclosures

LM declares that he has no competing interests.

Martin R. Turner, MA, MBBS, PhD, MRCP

MRC/MNDA Lady Edith Wolfson Clinician Scientist & Honorary Consultant Neurologist

Oxford University Department of Clinical Neurology

John Radcliffe Hospital

Oxford

UK

Disclosures

MRT is a co-author of "Motor Neuron Disease – A Practical Manual" (Oxford University Press, 2010), which is a summary of his own understanding and practice, and which strongly influenced the recommendations for revision of the current article. He receives a proportion of royalties derived from sales of this book.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Shoesmith C, Abrahao A, Benstead T, et al. Canadian best practice recommendations for the management of amyotrophic lateral sclerosis. CMAJ. 2020 Nov 16;192(46):E1453-68.Full text  Abstract

Andersen PM, Abrahams S, Borasio GD, et al. EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS) - revised report of an EFNS task force. Eur J Neurol. 2012 Mar;19(3):360-75.Full text  Abstract

Brooks BR, Miller RG, Swash M, et al; World Federation of Neurology Research Group on Motor Neuron Diseases. El Escorial revisited: revised criteria for the diagnosis of amyotrophic lateral sclerosis. Amyotroph Lateral Scler Other Motor Neuron Disord. 2000 Dec;1(5):293-9. Abstract

de Carvalho M, Dengler R, Eisen A, et al. Electrodiagnostic criteria for diagnosis of ALS. Clin Neurophysiol. 2008 Mar;119(3):497-503. Abstract

Shefner JM, Al-Chalabi A, Baker MR, et al. A proposal for new diagnostic criteria for ALS. Clin Neurophysiol. 2020 Aug;131(8):1975-8.Full text  Abstract

Miller RG, Jackson CE, Kasarskis EJ, et al; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: multidisciplinary care, symptom management, and cognitive/behavioral impairment (an evidence-based review). Neurology. 2009 Oct 13;73(15):1227-33.Full text  Abstract

Miller RG, Jackson CE, Kasarskis EJ, et al; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an evidence-based review). Neurology. 2009 Oct 13;73(15):1218-26. [Errata in: Neurology. 2009 Dec 15;73(24):2134; Neurology. 2010 Mar 2;74(9):781.]Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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