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These patterns are mirrored by phylogenetically young monosynaptic corticomotor neuronal connections. It is well known that, clinically, dysfunction of the deltoid muscle contributes considerably to the early disability of the ALS patient. In this study, we prospectively compared the degree of pareses of the deltoid muscle with the triceps and biceps brachii in <jats:italic>N<\/jats:italic>\u2009=\u200971 patients (426 muscles). We could show that the extent of involvement of the deltoid muscle early in the disease process resembles that of the biceps rather than the triceps brachii. This pattern is consistent with functional data of the corticospinal monosynaptic connectivity of all three muscles.<\/jats:p>","DOI":"10.1007\/s00415-025-12949-w","type":"journal-article","created":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T12:47:00Z","timestamp":1741265220000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The deltoid muscle and the pattern of paresis in ALS"],"prefix":"10.1007","volume":"272","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5401-0904","authenticated-orcid":false,"given":"Albert","family":"Ludolph","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronika","family":"Klose","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Dreyhaupt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Del Tredici","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heiko","family":"Braak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,6]]},"reference":[{"key":"12949_CR1","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1038\/nrneurol.2013.221","volume":"9","author":"H Braak","year":"2013","unstructured":"Braak H, Brettschneider J, Ludolph AC et al (2013) Amyotrophic lateral sclerosis \u2013 a model of corticofugal axonal spread. 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