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Most cases are driven by: chronic clenching (often stress-related) nighttime grinding (bruxism) muscle overuse bite imbalance Over time, the masseter muscles become overactive and enlarged, which leads to both pain and a heavier lower face

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Moreover, ALS is often further characterized by dysregulated proteostasis and autophagy, which can cause an excess of unfolded proteins, including stress granules, and TDP-43 pathologies

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