title: Triple stimulation technique (TST) in amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  The authors studied amyotrophic lateral sclerosis (ALS) patients using triple stimulation technique (TST) to detect upper motor neuron (UMN) involvement.
  
  
  METHODS
  Nineteen ALS patients (aged 45-72 years) were enrolled in the study. According to the El Escorial criteria, 6 diagnoses were suspected or possible, 6 probable, and 7 definite. Patients were examined clinically, with conventional (single-pulse) transcranial magnetic stimulation (TMS), and with TST (on one side only).
  
  
  RESULTS
  Among the whole group of patients, TST appeared to be more sensitive than conventional TMS techniques. In particular among suspected/possible ALS patients, TST area ratio was pathologic in 100%, while single-pulse TMS was abnormal only in 50% of cases. Overall, the use of TST area ratio was more sensitive than the analysis of TST amplitude ratio.
  
  
  CONCLUSIONS
  The results suggest that TST might be more sensitive and useful in the diagnosis of subclinical UMN involvement than conventional TMS techniques, even if TST is performed on one side only.
authors.affiliation: Medical State Academy Kasan, Tatarstan, Russia.
authors.forename: Leonid
authors.initials: L
authors.lastname: Komissarow
authors.forename: Jens D
authors.initials: JD
authors.lastname: Rollnik
authors.forename: Dessislava
authors.initials: D
authors.lastname: Bogdanova
authors.forename: Klaus
authors.initials: K
authors.lastname: Krampfl
authors.forename: F A
authors.initials: FA
authors.lastname: Khabirov
authors.forename: Andon
authors.initials: A
authors.lastname: Kossev
authors.forename: Reinhard
authors.initials: R
authors.lastname: Dengler
authors.forename: Johannes
authors.initials: J
authors.lastname: Bufler
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000503:physiopathology*; D004558:Electric Stimulation / Q000379:methods*; D019054:Evoked Potentials, Motor; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008280:Magnetics; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000473:pathology / Q000528:radiation effects*; D009046:Motor Neurons / Q000528:radiation effects*; D009431:Neural Conduction; D011930:Reaction Time; D012680:Sensitivity and Specificity