A prospective and blind study of the Triple Stimulation Technique in the diagnosis of ALS

Introduction: Demonstration of upper motor neuron (UMN) signs increases the accuracy of the diagnosis of ALS, but validated tests are lacking. The triple stimulation technique (TST) combines transcranial magnetic stimulation of the motor cortex with nerve stimulation at intervals appropriatie for collision. In open studies TST has a high sensitivity. Methods: Fifty-nine patients were recruited to undergo TST in addition to the standard work-up for suspected motor neuron disease. The neurologist making the diagnosis was blinded to the TST results. Primary outcome was the number of abnormal TST results in patients…