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To the Editor:
In their interesting paper, Kaufmann et al.1 report that central motor conduction time (CMCT) after transcranial magnetic stimulation (TMS) of the motor cortex may aid in the early diagnosis of ALS revealing a subclinical upper motor neuron involvement. They suggest that the diagnostic sensitivity of TMS could be improved by newer TMS techniques.
We emphasize that it is possible to increase the sensitivity of the standard CMCT study. In patients with motor neuron disease, we demonstrated a high percentage of subclinical abnormalities of CMCT that, in about one third of cases, were confined to the biceps brachii with normal CMCT …
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