A signature comprising 24 microRNAs has been linked to familial amyotrophic lateral sclerosis (ALS). Expression of these microRNAs was consistently reduced regardless of which ALS-linked gene patients carried. The downregulation was also observed in asymptomatic carriers of ALS-associated mutations up to 20 years before estimated disease onset. These microRNAs represent targets for novel ALS therapies, and might enable early intervention.