These results together with our observation of a lateral occipital brain damage in male patients may suggest a sex-related effect on cortical atrophy in ALS recalling that observed in ALS patients carrying C9orf72 repeat expansions in comparison to shorter disease duration (sporadic) patients (Agosta et al. 2017) and that induced by age in healthy men compared to women (Delvecchio et al. 2021). This evidence concerns the gene C9orf72 and Cerebral cortical atrophy.