Assessing Motor Neuron Disease Pathophysiology by Two Novel Methods - Threshold Tracking Transcranial Magnetic Stimulation and Magnetic Resonance Spectroscopy

Study Purpose:

Amyotrophic Lateral Sclerosis (ALS) is a motor neuron disease, which cases the death of neurons controlling the voluntary muscles. The death of motor neurons leads eventually to muscle weakness and muscle atrophy and as a consequence thereof, ALS patients die in average within three years after symptom onset due to respiratory failure.

No cure for ALS is currently known, and the medical diagnosis and clinical treatment are impeded by the lack of reliable diagnostic tools for objective disease assessment, and by the limited insight in disease pathophysiology since the underlying disease mechanisms still have not been fully elucidated.

An unbalance in the concentrations of GABA and glutamate, the most important inhibitory and excitatory brain metabolites, is suggested to play a role in the disease mechanisms of ALS. By applying Magnetic Resonance Spectroscopy (MRS), a magnetic resonance method which allows for quantification of brain metabolites, GABA and glutamate concentration can be quantified and thus hopefully elucidate their role in ALS disease mechanism.

Threshold Tracking Transcranial Magnetic Stimulation (TT-TMS) studies carried out by a single research group have demonstrated cortical hyperexcitability (a physiology state in which neurons in the cerebral cortex are easier activated) as an early feature in ALS patients. For this reason, TT-TMS was suggested as a biomarker of ALS by the research group. However, to be able to suggest a test as a biomarker, one must show the test is reliable and reproducible.

The objectives of this study are therefore: to explore the pathophysiology of ALS by investigating the interaction between neuronal networks as assessed by TT-TMS and conventional TMS and MRS, and to investigate the reliability and reproducibility of TT-TMS. The aim is to examine the utility of TT-TMS and MRS as diagnostic tools for objective detection of ALS in the early disease stage.

The study will include 60 participants in total, subdivided into two groups: 30 healthy participants and 30 patients with clinical suspicion of motor neuron disease or ALS. Each participant will undergo examination with TMS and MRS, the primary outcomes will be compared between the two groups and the results from the TMS examinations and the MRS-scans will be correlated.

Study Status:

Not recruiting


Amyotrophic Lateral Sclerosis , Motor Neuron Disease , Cortical Excitability

Study Type:


Type of Intervention:


Intervention Name:






Study Chair(s)/Principal Investigator(s):

Hatice Tankisi, MD, PhD, Department of Clinical Neuropysiology, Aarhus University Hospital ID:


Neals Affiliated?


Coordinating Center Contact Information

Study Sponsor:

Sándor Beniczky

Estimated Enrollment:


Estimated Study Start Date:

02 / 16 / 2018

Estimated Study Completion Date:

03 / 31 / 2022

Posting Last Modified Date:

01 / 14 / 2021

Date Study Added to

09 / 10 / 2018

Minimum Age:

45 Years

Maximum Age:


Inclusion Criteria:

Patients with

- possible, probable or definite ALS according to international criteria;

- progressive muscular atrophy;

- clinical suspicion of motor neuron disease or ALS

Healthy participants: no younger than 45 years of age

Exclusion Criteria:

Patients and healthy participants:

- ealier central or peripheral nervous system disease

- pacemaker or other implants

- pregnancy

- use of medications known to affect central nervous system

Department of Clinical Neurophysiology, Aarhus University Hospital

Aarhus 8000

Department of Neurology, Gazi University Hospital