OBJECTIVE: To assess whether Awaji criteria improve the sensitivity of diagnosis 
for amyotrophic lateral sclerosis (ALS). In Awaji ALS criteria, fasciculation 
potentials are regarded as evidence of acute denervation in the presence of 
chronic neurogenic changes on needle electromyography.
METHODS: We reviewed clinical and neurophysiological data of 113 consecutive 
patients who were suspected as suffering ALS. The six muscles (trapezius, 
biceps, first dorsal interosseous, T10-paraspinalis, vastus lateralis, and 
tibialis anterior muscles) were examined by EMG, focusing on the presence of 
fasciculation potentials. The sensitivity of revised El Escorial (R-EEC) and 
Awaji criteria was compared.
RESULTS: Probable or definite ALS was diagnosed in 61% of the patients by R-EEC 
and 71% by Awaji criteria. By applying Awaji criteria; (1) 17 of the 44 patients 
categorized as possible ALS by R-EEC reached to probable/definite ALS, 11 of 
whom had bulbar onset, (2) in 48 patients with bulbar onset, the proportion of 
probable/definite ALS increased from 59% to 82%, (3) in 62 patients with limb 
onset, the proportion of probable/definite ALS was 61% (63% by R-EEC).
CONCLUSIONS: Awaji criteria improve the sensitivity of ALS diagnosis in patients 
with bulbar onset, but not in those with limb onset.
SIGNIFICANCE: Accepting fasciculation potentials as evidence of acute 
denervation increases the diagnostic sensitivity of ALS, particularly in 
patients with bulbar onset, and contributes to early diagnosis.