cqvip:To further investigate the pathophysiology of amyotrophic lateral sclerosis (A LS), the silent period (SP) evoked by transcranial magnetic stimulation during a fatiguing muscle contraction was evaluated in 15 patients and in 15 healthy sub jects. Physiological lengthening of the SP duration was not observed in patients with disease duration of ≥2 years.Decreased intracortical inhibition, probably secondary to dysfunction of the inhibitory interneurons that modulate the corti comotoneuronal firing, appears in later stages of disease.Normal motor cortex ad aptation is impaired and cortical hyperexcitability might be unmasked during fatigue in ALS patient s with longer disease duration.
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