“…One of our most striking findings is that TMS was more sensitive than clinical examination in patients with suspected or possible ALS, revealing UMN dysfunction in 75% (9 of 12) of the upper limbs. The sensitivity of CMCT in supporting the diagnosis reportedly increases with the number of muscles studied, 10,12,14,35,38,40,47 and this may apply to the parameters studied herein. We believe that, as for electromyography, several regions of the body, including muscles innervated by bulbar nerves, should be tested to increase the sensitivity of TMS in supporting a diagnosis of ALS.…”