GPAtlas🧭 When to suspect
Suspect motor neurone disease (MND) in any adult with progressive, painless muscle weakness and wasting in the absence of sensory loss. The hallmark is a combination of upper motor neurone (UMN) and lower motor neurone (LMN) signs, often with asymmetrical, distal weakness. Amyotrophic lateral sclerosis (ALS) is the commonest form (around 85%), and median survival is roughly 2–4 years from symptom onset.
MND is rare – a GP will see perhaps 1–2 cases in a career – so the key primary-care skill is recognition and timely referral, not making the diagnosis. Symptoms are frequently misattributed, and around a third of patients are first sent to a non-neurology specialty (e.g. ENT, orthopaedics), contributing to an average diagnostic delay of about 12 months.
| Onset pattern | Approx. frequency | Hallmark features |
|---|---|---|
| Limb onset | ~70% | Focal, asymmetrical, often distal weakness – loss of dexterity (buttons, zips), dropping things, foot drop, trips and falls. |
| Bulbar onset | ~25% | Painless, progressive dysarthria (slurred/hoarse speech, worse when tired) ± dysphagia; tongue wasting and fasciculations. |
| Respiratory onset | Uncommon | Unexplained breathlessness, orthopnoea, morning headache, daytime sleepiness – an easily missed presentation. |
The single most useful pattern to hold in mind is progressive + painless + no sensory loss + mixed UMN/LMN signs. If that picture fits, refer urgently rather than waiting for primary-care tests.
Source: NICE NG42 · MND Association
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