Finally, SBMA and ALS are in differential diagnosis, and a substantial proportion of patients with SBMA initially receive a diagnosis of ALS, causing distress.24 Although genetic clinical testing is the gold standard for SBMA diagnosis, the finding of normal levels of NfL in SBMA could be used in a diagnostic panel of biochemical markers to help differentiate patients presenting with motor neuron deficits. The gene discussed is NEFL; the disease is Kennedy disease.