Staging system for ALS is important for clinical practice. Howerer, the validation of the mechanism that underneath the proposed stages in ALS remains unclear. We used surface-based cortical morphology and more precise anatomical evaluation for 72 patients at different stages and 88 controls, confirmed the consecutive involvement of cortical thinning in PrG along disease progression. Moreover, the extensive but similar PrG involvement in patients at stage 2 and stage 3, highlighted a critical therapeutic window from stage 1 to stage 2, and also underlined the incorporation of cortical evaluation as additional features to King’s clinical stages for promising clinical management.
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