Impaired motor cortex inhibition in patients with ALS

To the Editor: We read with interest the article by Ziemann et al.1 on corticocortical inhibition in patients with ALS. They studied ALS patients using several magnetic stimulation methods. Their main finding was reduced inhibition by paired-pulse magnetic stimulation. They suggest that this is due to the hyperexcitability of the motor cortex in ALS patients. Their conclusion is compelling, especially when considering the suspected pathomechanisms for ALS.2 We were inclined to make the same conclusion when we studied ALS patients using the same paired-pulse stimulation method.3 …