The long interval between first symptoms and a confirmed ALS diagnosis, which can be as long as 18 months, limits many patients from participating in clinical trials early in the course of disease when interventions may have a greater therapeutic effect. A new neurophysiological tool called threshold-tracking transcranial magnetic stimulation (TMS) can distinguish ALS from non-ALS ‘mimic’ neuromuscular disorders in early stages of the disease, according to work presented at the 2015 American Academy of Neurology Annual Meeting. Nimeshan Geevasinga and colleagues from the University of Sydney, Australia, report that in a study of 333 patients with definite, probable, or possible ALS, or affected by other neuromuscular disorders, the TMS method distinguished ALS from non-ALS mimic disorders with a sensitivity of 73% and specificity of 82%. With further validation, this approach could be used not only for diagnostic purposes, but also to assess drug efficacy. In fact, TMS is being incorporated as an assessment tool in the clinical trial of retigabine.
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