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Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease characterized by degeneration and eventual death of upper motor neurons and lower motor neurons causing weakness of the limb, respiratory, and bulbar musculature. The incidence of ALS is 1.52 per 100,000 person-years, with a prevalence of 5.0 cases per 100,000 in 2013. (1) Prevalence varies with: