Table 1.

ALS diagnostic criteria.

Criteria	Revised El Escorial Criteria (rEEC)	Awaji Criteria	Gold Coast Criteria (GCC)
Purpose	Diagnosis and classification of ALS	Diagnosis and classification of ALS	Diagnosis and classification of ALS
Date Established	Revised in 2000 (earlier versions from 1998)	Revised in 2008	Revised in 2019
Diagnostic Categories	Definite ALS: Clinica evidence of upper and lower motor neuron involvement in three regions.	Definite ALS: Clinical and/or electrophysiological evidence of upper and lower motor neuron involvement in at least two regions.	Definite ALS: Clinical evidence of upper and lower motor neuron involvement in one region or lower motor neuron involvement in at least two regions.
	Probable ALS: Clinical evidence of upper and lower motor neuron involvement in two regions.	Probable ALS: Clinical and/or electrophysiological evidence of upper and lower motor neuron involvement in one or two regions.	NA
	Probable lab. supp: Clinical evidence of upper and lower motor neuron involvement in one region or upper motor neuron involvement alone with EMG lower motor neuron involvement in two regions.	NA	NA
	Possible ALS: Clinical evidence of upper and lower motor neuron involvement in one region or upper motor neuron involvement in two more regions or lower motor neuron involvement rostral to upper motor neuron.	Possible ALS: Clinical evidence of upper and lower motor neuron involvement in one region or upper motor neuron involvement in two or more regions or lower motor neuron involvement rostral to upper motor neuron.	NA
Electrophysiological criteria	Requires specific findings (e.g., electromyography) to support the diagnosis.	Emphasizes Electrophysiological findings. (Evidence of denervation and reinnervation).	Less emphasis on specific electrophysiological findings; clinical presentation is prioritized.
Genetic Testing	Not required but may support diagnosis if applicable.	Genetic testing is encouraged, especially for familial history of ALS.	Genetic testing is encouraged, particularly for familial history of ALS and atypical presentations.
Application	Primarily used for research and clinical diagnosis.	Widely used for clinical diagnosis, reflecting an update from previous criteria.	Used for clinical diagnosis and research, with updated guidelines reflecting current practices.