Background Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that affects both upper and lower motor neurons, disturbing communication between the brain and muscles. So far, few reports have been published for the SPG11 -associated ALS, and this is the first documented case from Pakistan. Methods We report a rare subtype of ALS with an autosomal recessive mode of inheritance with juvenile onset before 25 years...