Prognostic value of decremental responses to repetitive nerve stimulation in ALS patients

Decrement of the thenar compound muscle action potentials (CMAP), after repetitive nerve stimulation (RNS) of the median nerve at 3 Hz, was evaluated in patients with ALS before riluzole therapy. CMAP size as well as motor unit number and size estimates were evaluated twice before and after 1 year of riluzole therapy. The correlation between decrement and CMAP size reduction per year was highly significant (r = 0.77), but no relationship could be demonstrated between decrement and other variables. The authors thus propose that decrement after RNS may be used as a predictor of further drop in CMAP size.