Clinical presentation with amyotrophic lateral sclerosis (ALS) is thought to follow a presymptomatic stage of neurodegeneration. Using magnetic resonance spectroscopy, Carew et al. investigated the neurometabolic profile of the cervical spine in individuals who were genetically predisposed to develop ALS. This group showed neurometabolite ratios that were different to those of controls and similar to those seen in patients with ALS. Neurometabolic changes might, therefore, be used as an early marker of the disease.