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Background and purpose Pompe disease is a rare inheritable muscle disorder for which enzyme replacement therapy ( ERT) has been available since 2006. Uniform criteria for starting and stopping ERT in adult patients were developed and reported here. Methods Three consensus meetings were organized through the European Pompe Consortium, a network of experts from 11 European countries in the field of Pompe disease. A systematic review of the literature was undertaken to determine the effectiveness of ERT in adult patients on a range of clinical outcome measures and quality of life. A narrative synthesis is presented. Results Consensus was reached on how the diagnosis of Pompe disease should be confirmed, when treatment should be started, reasons for stopping treatment and the use of ERT during pregnancy. This was based on expert opinion and supported by the literature. One clinical trial and 43 observational studies, covering a total of 586 individual adult patients, provided evidence of a beneficial effect of ERT at group level. At individual patient level, the response to treatment varied, but factors associated with a patient's response to ERT were not described in many studies. Eleven observational studies focused on more severely affected patients, suggesting that ERT can also be beneficial in these patients. There are no studies on the effects of ERT in pre-symptomatic patients. Conclusions This is the first European consensus recommendation for starting and stopping ERT in adult patients with Pompe disease, based on the extensive experience of experts from different countries. [ABSTRACT FROM AUTHOR]

However, we completely agree with Dr Gazulla et al.'s assumption that PLS, like ALS, is not a pure motor neurone disease but rather a multisystem neurodegenerative disease defined by a predominant motor system injury. Moreover, Bede's team has demonstrated the existence of cerebellar atrophy in sporadic ALS and in ALS linked to I C9orf72 i abnormal G4C2 expansion [5,6]. We read with great interest the letter of Drs Gazulla and collaborators, who suggested that the continuum between primary lateral sclerosis (PLS) and amyotrophic lateral sclerosis (ALS) is not straightforward [1]. [Extracted from the article]