Diagnosis of MND

MND can present in different ways depending on the pattern of motor neurone involvement. Symptoms are typically progressive and painless.

Common early features may include:

• progressive, focal muscle weakness, for example hand weakness or foot drop
• muscle wasting or fasciculations
• slurred or unclear speech (dysarthria)
• difficulty swallowing (dysphagia)
• reduced grip strength or loss of dexterity
• changes in mobility, including trips or falls.

Symptoms often begin in one area and gradually spread to other regions over time, for example from one limb to another, or from limb to speech and swallowing. This progression is a key feature.

A lack of sensory symptoms is a typical feature.

Some people may also experience cognitive or behavioural changes, including features of frontotemporal dementia (FTD), such as changes in personality, behaviour or decision making.

In a small number of cases, MND may present with respiratory symptoms, such as unexplained breathlessness or orthopnoea.

Consider the possibility of MND if symptoms are:

• progressive and worsening over time
• starting focally and spreading to other regions
• not explained by a single focal lesion
• involving both upper and lower motor neurone signs.

A lack of sensory symptoms is also a key feature.

Signs may include a combination of:

• lower motor neurone signs, such as muscle wasting, weakness and fasciculations
• upper motor neurone signs, such as brisk reflexes, spasticity and increased tone

Pay particular attention to:

• bulbar symptoms, such as dysarthria or dysphagia
• respiratory symptoms, such as unexplained breathlessness.

MND is uncommon, and many people presenting with these symptoms will have another diagnosis. However, maintaining clinical suspicion is important where symptoms are progressive or spreading.

If you suspect MND, refer urgently to neurology.

Key actions:

• make an urgent referral to a neurologist
• include clear clinical details, including onset and progression of symptoms
• highlight any bulbar or respiratory symptoms
• consider immediate safety risks, including swallowing difficulties, aspiration risk and falls.

Do not delay referral while awaiting investigations in primary care. These are unlikely to exclude MND and may delay specialist assessment.

Where possible, use local urgent referral pathways.

If in doubt, refer.

The Red Flags tool has been developed to support earlier recognition of possible MND in primary care.

It highlights patterns of symptoms that should prompt consideration of MND and referral to neurology.

View Red Flags tool

People may present with uncertainty or anxiety about their symptoms. At this stage, there is usually no confirmed diagnosis.

• be open about the need for further assessment
• explain the reason for referral clearly
• avoid speculation about diagnosis
• offer reassurance that they will be seen by a specialist.

You may find the following resources helpful:

NICE guideline NG42: Motor neurone disease: assessment and management

Diagnosis training film

Information for GPs

MND Association resources for health and social care professionals

Information and support for people with and affected by MND

You can find further guidance on symptom management and support across the Management of MND section.