Amyotrophic Lateral Sclerosis (ALS), Comprehensive Genetic Testing

The Comprehensive Genetic Test for Amyotrophic Lateral Sclerosis (ALS) utilizes next-generation sequencing (NGS) to examine 35 genes associated with Amyotrophic Lateral Sclerosis (ALS) and related neurodegenerative disorders. It is a targeted gene panel specifically designed to support accurate diagnosis, risk assessment, and prevention.

More Information

The Comprehensive Genetic Test for Amyotrophic Lateral Sclerosis (ALS) is a specialized genetic test designed to evaluate genes associated with ALS, including selected non-coding variants. It is intended for use in individuals with a clinical suspicion or confirmed diagnosis of Amyotrophic Lateral Sclerosis (ALS), a progressive neurodegenerative disorder affecting motor neurons. The comprehensive genetic test for Amyotrophic Lateral Sclerosis (ALS) supports the identification of genetic contributors to disease onset and progression, facilitating a more precise understanding of the underlying etiology. It should be noted that the comprehensive genetic test for Amyotrophic Lateral Sclerosis (ALS) does not assess the hexanucleotide repeat expansion in the non-coding region of the C9orf72 gene, which may require separate evaluation.

The comprehensive genetic test for Amyotrophic Lateral Sclerosis (ALS) includes genes involved in key neuronal processes such as RNA metabolism, protein homeostasis, cytoskeletal integrity, and axonal transport. Prominent genes such as SOD1, TARDBP, FUS, and OPTN play critical roles in oxidative stress regulation, RNA binding and processing, and intracellular protein degradation pathways. Disruption of these functions contributes to motor neuron vulnerability and degeneration. These molecular pathways are essential for maintaining neuronal stability and function. The comprehensive genetic test for Amyotrophic Lateral Sclerosis (ALS) is indicated in individuals presenting with clinical features suggestive of ALS or related motor neuron disorders.

Amyotrophic Lateral Sclerosis (ALS) is characterized by progressive degeneration of upper and lower motor neurons, leading to muscle weakness, atrophy, spasticity, and eventual paralysis. Clinical manifestations may include limb weakness, dysarthria, dysphagia, and respiratory compromise. Disease progression and presentation are highly variable, with some individuals experiencing rapid decline while others exhibit slower progression. Distinct phenotypes such as limb-onset ALS, bulbar-onset ALS, and primary lateral sclerosis may be observed. Although most cases are sporadic, a subset demonstrates familial inheritance, most commonly in an autosomal dominant pattern, with less frequent autosomal recessive or X-linked forms.

The primary purpose of the comprehensive genetic test for Amyotrophic Lateral Sclerosis (ALS) is to identify pathogenic variants associated with Amyotrophic Lateral Sclerosis (ALS), thereby supporting diagnostic confirmation and enabling a deeper understanding of disease mechanisms. The detection of causative variants contributes to improved classification of ALS subtypes and enhances the ability to distinguish Amyotrophic Lateral Sclerosis (ALS) from other neurodegenerative or neuromuscular conditions. Furthermore, genetic findings may provide insights into disease prognosis and contribute to broader research efforts to understand genotype-phenotype correlations and disease heterogeneity.

A higher genetic risk is confirmed when pathogenic mutations are found in ALS-associated genes included in the panel. A lower risk may be inferred when no mutations are detected, though comprehensive clinical follow-up is still essential. The integration of genetic data with clinical findings and family history is critical for precise diagnosis, prognosis, and long-term patient care.

The test is performed in a clinical laboratory accredited to ISO 15189 and certified by CLIA and CAP, ensuring the validity, accuracy and international recognition of the results.

Genes and Associated Phenotypes (Comprehensive Genetic Testing for Amyotrophic Lateral Sclerosis, ALS)

Genetic testing for this gene is performed by taking a blood sample or by taking genetic material from inside the cheeks (with a swab), and can be done:

• By taking the sample at Diagnostiki Athinon. Book your appointment in real-time and purchase the test online
• By taking the sample at home. We send you all the necessary collection materials to your home via courier. The courier also returns the sample to the laboratory. Purchase the test online

Test Strengths

The test is characterized by the following strengths:

• This panel includes genes associated with amyotrophic lateral sclerosis (ALS) and frontotemporal dementia, BSCL2-related neurological disorders, DCTN1-associated distal hereditary motor neuronopathy type VIIB, GBE1-related adult polyglucosan body disease, and inclusion body myopathy linked to Paget disease of bone and/or frontotemporal dementia (IBMPFD).
• Analysis is performed in a CAP-accredited laboratory with the participation of CLIA-certified personnel.
• Advanced sequencing technologies, high-performance target enrichment methods, and precise bioinformatics pipelines ensure superior analytical performance.
• Gene panels are carefully designed to be clinically effective and scientifically validated.
• In some panels, the entire mitochondrial genome is included (see Panel Content section).
• Approximately 2,000 non-coding disease-causing variants are covered in the clinical-grade NGS assay (see Non-coding disease-causing variants covered by this panel in the Panel Content section).
• A rigorous variant classification system is applied.
• A systematic interpretation workflow, supported by proprietary software, enables accurate and traceable processing of NGS data.
• Comprehensive and clinically meaningful reports are provided.

Test Limitations

Specific technical and biological limitations apply:

• This panel does not cover the analysis of the hexanucleotide repeat expansion found in the non-coding region of the C9orf72 gene.
• Genes with suboptimal coverage are marked with a number sign (#), while those with partial or complete segmental duplications overlapping UCSC pseudogene regions are marked with an asterisk (*).
• A gene is considered to have suboptimal coverage when more than 90% of its target nucleotides are not covered at a depth of greater than 20x with mapping quality score (MQ > 20) reads. In such cases, detection of variants may be limited.

This test does not detect:

• Complex inversions
• Gene conversions
• Balanced translocations
• Repeat expansion disorders, unless otherwise specified
• Non-coding variants beyond ±20 base pairs from the exon–intron boundary, unless otherwise indicated
• The complete mitochondrial genome in all panels (see Panel Content section

This test may not reliably detect:

• Low-level mosaicism in nuclear genes (variants with a minor allele fraction of ~14.6% are detected with 90% probability)
• Stretches of mononucleotide repeats
• Low-level heteroplasmy in mtDNA (>90% detected at 5% level)
• Insertions or deletions larger than 50 bp
• Single-exon deletions or duplications
• Variants within pseudogene regions or duplicated genomic segments
• Disease-causing mtDNA variants not present in blood; in such cases, post-mitotic tissue (e.g., skeletal muscle) may be required to establish a molecular diagnosis

For further details, please refer to the Bioinformatics & Performance section.

Bioinformatics

The target region for each gene encompasses the coding exons as well as ±20 base pairs from the exon–intron boundaries. In addition, the panel may include non-coding and regulatory variants, as listed in the “Non-coding variants covered by the panel” section. Specific regions of certain gene(s) may be excluded from analysis if noted in the “Test limitations” section. When the test includes the mitochondrial genome, the target region also comprises the complete set of mitochondrial genes.

Sequencing data is processed through a proprietary analysis and annotation pipeline that integrates state-of-the-art algorithms and industry-standard software solutions. Multiple quality control steps are embedded throughout the workflow to ensure the accuracy, validity, and consistency of the results. The pipeline is optimized to maximize sensitivity without compromising specificity.

For variant interpretation, the system incorporates data from multiple reference populations and mutation databases, including (but not limited to) the 1000 Genomes Project, gnomAD, ClinVar, and HGMD. In silico tools such as SIFT, PolyPhen, and MutationTaster are also applied to support the classification of missense variants.

All findings are summarized in a clear and detailed clinical report. This report includes sequencing quality metrics, gene-level coverage information, and highlights any regions where coverage is limited (<20x for nuclear genes and <1000x for mtDNA, when applicable). This ensures transparency and supports accurate clinical decision-making.

Test Performace

The genes included in this panel have been carefully selected based on evidence from scientific literature, mutation databases, and accumulated clinical expertise.

All panels are derived from a high-quality, clinical-grade NGS assay. Details regarding the detection of different types of genetic alterations are provided in the sequencing and detection performance table (see Table).

The assay has been validated for several sample types, including EDTA blood, isolated DNA (excluding DNA from formalin-fixed paraffin-embedded tissue), saliva, and dried blood spots (filter cards). These sample types were chosen to maximize the probability of obtaining high-quality DNA. The diagnostic yield may vary depending on the assay performed, the referring healthcare professional, the hospital, and the country in which the test is conducted. The Plus Analysis further enhances the chance of reaching a genetic diagnosis, as large deletions and duplications cannot be detected by sequencing alone. This approach integrates both sequencing and deletion/duplication (copy number variant, CNV) analysis.

The performance metrics shown below are based on initial validation studies at an accredited clinical laboratory, with equivalent results confirmed across additional laboratory sites.

Performance of a high-quality, clinical-grade NGS sequencing assay for panels

Coverage metrics

Performance of Mitochondrial Sequencing Assay

Mitochondrial assay coverage metrics

Comprehensive clinical reports are delivered, designed to provide healthcare professionals with meaningful and actionable insights. Clinical interpretation requires a solid understanding of both clinical genetics and genetic principles. Reports are prepared by teams of molecular geneticists, medical experts, and other highly experienced professionals, who evaluate identified variants in the context of the patient’s phenotypic information provided in the requisition form.

The goal is to ensure that reports are clinically valuable and understandable to all healthcare providers, regardless of their level of training in genetics and genetics-related fields. Variant classification forms the foundation of clinical interpretation and guides patient management decisions. Classifications follow the ACMG 2015 guidelines. Sequence and copy number variants classified as pathogenic, likely pathogenic, or of uncertain significance (VUS) are confirmed using bidirectional Sanger sequencing or orthogonal methods such as qPCR/ddPCR whenever NGS quality metrics do not meet strict thresholds for a true positive call.

Each report includes tables for sequence and copy number variants, presenting essential information such as genomic coordinates, HGVS nomenclature, zygosity, allele frequencies, in silico predictions, phenotypic correlations, and variant classification. In addition, detailed descriptions are provided for the variant, the gene, and the related phenotypes, covering the gene’s role in human disease, mutation spectrum, variation in population cohorts, and links to associated conditions. References, abstracts, and variant databases are also cited, enabling healthcare providers to further evaluate reported findings if desired.

Reports are structured into two sections: primary findings and additional findings.

The primary findings consist of variants known to cause disease or rare variants that may explain the patient’s phenotype. The conclusion summarizes all available evidence and presents the rationale for classification.

Additional findings include variants that are not currently sufficient to explain the patient’s phenotype, based on existing knowledge. Examples include heterozygous variants in autosomal recessive genes, VUS in autosomal dominant genes (when a pathogenic or likely pathogenic variant already explains the phenotype), or risk alleles in genes included in the panel.

The identification of pathogenic or likely pathogenic variants in dominant disorders, or biallelic variants in recessive disorders, is considered molecular confirmation of the clinical diagnosis. In such cases, family testing may assist in risk assessment. Variants of uncertain significance are not recommended for patient management or family risk stratification. Genetic counseling is strongly advised.

Interpretation teams routinely analyze millions of variants across thousands of cases of rare diseases. With each case, internal knowledge of variant–phenotype relationships is enriched, enabling continuous refinement of classifications. As new evidence becomes available, previously reported variants may be reclassified. If a variant initially reported as a primary or secondary finding is later reclassified (for example, from VUS to pathogenic/likely pathogenic, or from pathogenic/likely pathogenic to VUS, likely benign, or benign), an updated statement is issued to the original ordering healthcare provider at no additional cost.