Do you screen for any environmental exposures in patients with newly diagnosed ALS?

I would at least ask the questions when obtaining history-specifically regarding occupational exposure to heavy metals like mercury, lead or arsenic. There is also a theory about BMAA a toxic aminoacid made by Cyanobacteria that may explain clusters of ALS-like or Parkinsonian syndrome that occurred previously in the Guam region and could relate to excessive consumption of certain kinds of seafood like blue mussels, oysters, etc-this is interesting but still a bit unclear. Do I routinely test for heavy metals in blood and/or urine in patients with suspected ALS? No, unless the history does not suggest exposure. I have some doubts whether a classic ALS phenotype-ie a pure upper and lower motor neuron syndrome progressing over months to 1-2 y...

Risk factors of amyotrophic lateral sclerosis: a global meta-summary (published in Frontiers of Neuroscience in April 2023) looked at genetic and non-genetic risk factors for ALS. 230 eligible studies were included, of which 67 involved 22 non-genetic factors, and 163 involved genetic factors. Four aspects of non-genetic factors, including lifestyle, environmental and occupational exposures, pre-existing diseases/comorbidities, medical exposures, and other non-genetic risk factors were analyzed.

They found 8 non-genetic factors that significantly increase the risk of developing ALS. One of these was exposure to heavy metals. The other 7 were exposure to a magnetic field, exposure to lead, exposure to pesticides/ herbicides, insecticides/solv...