Why averaging multiple MUNIX measures in the longitudinal assessment of patients with ALS?

Amyotrophic lateral sclerosis (ALS), a terminal degenerative disease of the upper and lower motor neurons (LMN), lacks reliable lower motor neuron disease progression biomarker. Clinical assessment, functional scales, and routine electrophysiological parameters are insensitive in detecting subtle lower motor neuron degeneration as muscle strength and compound muscle action potential (CMAP) can remain stable despite progressive subclinical LMN loss and reinnervation (Neuwirth et al., 2017).

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