A 59 year old man initially presented with weakness in his right leg and occasional trips. He had a longstanding history of mild low back pain and had a magnetic resonance image performed under the orthopaedic team that showed some cervical spondylolisthesis sparing the spinal cord. Four months after this, he went back to the general practitioner with progressive difficulty buttoning his shirt. Motor neurone disease is a devastating, incurable neurodegenerative disease of the motor neurones that primarily affects people in their 60s or 70s.1 Of the four subtypes of motor neurone disease, the most common is amyotrophic lateral sclerosis.2 The subtypes vary clinically because they predominately affect different areas and have varying rates of progression. #### How common is it? Although motor neurone disease is a relatively well known rare disease, most GPs will diagnose only one or two cases in their career. There is a lack of awareness of the symptoms at presentation, when symptoms are often subtle.3 The disease affects …