INTRODUCTION: Recently, some authors have claimed that the Awaji criteria (AC) 
are not always more sensitive than the revised El Escorial criteria (rEEC) in 
amyotrophic lateral sclerosis (ALS).
METHODS: A meta-analysis examined 2 prospective and 7 retrospective studies, 
which included 1,121 ALS patients, to compare AC and rEEC for early diagnosis of 
ALS.
RESULTS: AC led to an 11% greater likelihood of being classified into the 
categories "clinically definite" or "clinically probable", while if confined to 
the "clinically probable - laboratory supported (LS)" category, this effect was 
40% higher with the rEEC (95% cnfidence interval, 3-82%; I2=98%). Specifically, 
AC downgraded 20% of the rEEC "clinically probable - LS" category to the AC 
"clinically possible".
CONCLUSIONS: Despite overall superiority of AC, this meta-analysis shows that it 
is not always more sensitive than rEEC. These results are related to the 
requirement for 2 upper motor neuron signs in the AC "clinically probable" 
category.