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ALS is mostly diagnosed based on clinical signs, using the revised El Escorial criteria, which require signs of both upper motor neuron (e.g., spasticity, brisk reflexes) and lower motor neuron damage (e.g., muscle wasting, twitching) in multiple body regions (Brotman et al., 2025)

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Biosci Biotechnol Biochem 61(12):19771980 Van Der Werf P, Orlowski M, Meister A (1971) Enzymatic conversion of 5-oxo-L-proline (L-pyrrolidone carboxylate) to L-glutamate coupled with cleavage of adenosine triphosphate to adenosine diphosphate, a reaction in the -glutamyl cycle

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Patients often notice better energy, improved recovery, and more stable metabolism, which helps them stay consistent with exercise and healthy habits