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Beyond clinical definition, two neurophysiological ratios and one index have been proposed to quantify this pattern. It is considered a potential diagnostic criterion for amyotrophic lateral sclerosis (ALS). Its occurrence in immune-mediated neuropathies, as differential diagnoses, remains unclear. We aimed to investigate clinical and electrophysiological manifestations of split-hand syndrome in multifocal motor neuropathy (MMN) and multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) compared to ALS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We prospectively examined 26 MMN, 16 MADSAM, and 22 ALS patients. All underwent neurological examination and neurophysiological measurements of compound muscle action potentials (CMAP) from the APB, FDI, and ADM bilaterally after median (APB) and ulnar nerve (FDI, ADM) stimulation. Split-hand ratios (APB\/ADM; FDI\/ADM) and split-hand index (SI) were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Clinical split-hand syndrome was present in 16\/26 (62%) MMN, 7\/16 (44%) MADSAM, and 12\/22 (54%) ALS patients. Electrophysiological criteria (abnormal split-hand ratios or SI;\u2009\u2265\u20091 parameter fulfilled) were similarly frequent across groups (MMN 17\/26, 65%, MADSAM 11\/16, 69%, and ALS 16\/22, 73%). CMAP ratios and SI did not differ between groups in the overall analysis and showed no correlation with disease duration or severity. Diagnostic models showed limited discriminatory power (area under the curve\u2009\u2264\u20090.61).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Split-hand syndrome occurs in MMN, MADSAM, and ALS at comparable frequencies and lacks robust or consistent diagnostic discrimination across disease groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-14006-6","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:50:54Z","timestamp":1784310654000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond ALS: split-hand syndrome in immune-mediated motor neuropathies"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4369-3866","authenticated-orcid":false,"given":"Luisa","family":"Kre\u00df","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9857-1818","authenticated-orcid":false,"given":"Mai","family":"Abuzant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3393-5657","authenticated-orcid":false,"given":"Daniel","family":"Zeller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7064-5002","authenticated-orcid":false,"given":"Claudia","family":"Sommer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"14006_CR1","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.clinph.2022.08.020","volume":"143","author":"WZ Lu","year":"2022","unstructured":"Lu WZ, Lin HA, Hou SK, Lee CF, Bai CH, Lin SF (2022) Split-hand index for amyotrophic lateral sclerosis diagnosis: a frequentist and Bayesian meta-analysis. 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DZ has received honoraria from Angelini Pharma for a talk, consulting fees from Novartis, travel support from Angelini Pharma and Zambon GmbH, and has served on an advisory board for Biogen. CS has received honoraria as a speaker and\/or consultant from Algiax, Akigai, Amicus, Alnylam, Annexon, Argenx, CSL Behring, Grifols, Kedrion, Orion, Pfizer, Sanofi, Takeda, and TEVA. She is an advisor for the GBS\/CIDP Foundation International.","order":1,"name":"Ethics","label":"Conflicts of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Committee of the University of W\u00fcrzburg (#229\/22) and conducted in accordance with the ethical standards of the Declaration of Helsinki and its later amendments. All participants provided written informed consent prior to inclusion in this study.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"471"}}