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The phenotypes of onset region, propagation and motor neuron involvement were analyzed according to the OPM classification. Serum NfL (sNfL)\u00a0was measured and related to ALS progression (ALSPR, monthly change of ALS Functional Rating Scale\u2013Revised). To quantify NfL elevation relative to ALSPR, the logNfL(index), the log-transformed ratio of sNfL to ALSPR was calculated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      <jats:italic>C9orf72<\/jats:italic>\n                      -associated ALS showed frequent bulbar onset (n\u2009=\u200942.6%), higher ALSPR (0.95, SD 0.84), highest NfL (116.3, SD 72.7\u00a0pg\/mL) and logNfL(index) (5.02, SD 0.88).\n                      <jats:italic>SOD1-<\/jats:italic>\n                      ALS had mostly limb onset (n\u2009=\u200996.1%), slower ALSPR (0.57, SD 0.60), high NfL (76.1, SD 61.4\u00a0pg\/mL) and a comparably high logNfL(index) (4.94, SD 1.03).\n                      <jats:italic>FUS<\/jats:italic>\n                      -ALS exhibited mostly limb onset (82.4%), lower motor neuron dysfunction (70.6%), a wide range of faster (22.2%) to slower ALSPR (55.6%), lower NfL (66.2, SD 32.9) and logNfL(4.65, SD 0.9).\n                      <jats:italic>TARDBP-<\/jats:italic>\n                      ALS displayed the lowest ALSPR (0.53, SD 0.52), the lowest NfL (43.3, SD 31.8 pg\/mL) and the lowest logNfL(index) (4.40, SD 0.7).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      In\n                      <jats:italic>C9orf72<\/jats:italic>\n                      -ALS, the phenotype and NfL profile are close to typical ALS. The finding of distinct phenotypes and NfL patterns in\n                      <jats:italic>SOD1<\/jats:italic>\n                      -,\n                      <jats:italic>FUS<\/jats:italic>\n                      - and\n                      <jats:italic>TARDBP-<\/jats:italic>\n                      associated ALS underscores the relevance of genetic ALS for prognostic counseling, clinical trial design, treatment expectations and unraveling of pathogenic mechanisms in ALS.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-025-13555-6","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T17:05:25Z","timestamp":1765559125000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Motor phenotypes and neurofilament light chain in genetic amyotrophic lateral sclerosis\u2014results from a multicenter screening 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TM and CM are founders and shareholders of the Ambulanzpartner Soziotechnologie APST GmbH, which makes the mobile application \u201cALS-App.\u201d TG has received personal fees from ITF Pharma and served on the advisory boards of Amylyx and ITF Pharma outside of the submitted work. SP has received speaker fees, non-financial support and research support from Biogen, Roche, ALS Pharma, Amylyx, Cytokinetics, Ferrer, ITF Pharma, and Sanofi and served on advisory boards of Amylyx, Biogen, Roche, Zambon and ITF Pharma outside of the submitted work. PW has served on advisory boards of Biogen, ITF Pharma and Novartis outside of the submitted work. RG has received grants, personal fees, non-financial support and research support from Biogen and served on the advisory boards of Biogen, Roche, and ITF Pharma outside of the submitted work. MV received travel expenses and non-financial support from ITF Pharma outside of the submitted work. AM has received personal fees, non-financial support, and research support from ITF Pharma and Zambon outside the submitted work. PK received consulting fees from Biogen. The other authors declare no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. The study protocol was ethically approved under numbers EA2\/168\/20 and EA1\/219\/15.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"22"}}