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Correspondingly, trials where baseline EMG amplitude exceeds a specified threshold are often rejected. We aimed to investigate the influence of motor activity below such a threshold of MEP amplitude. We retrospectively analysed TMS\u2010EMG data collected during resting MT (RMT) measurement in 45 healthy control subjects (1794 data points) and 35 people with amyotrophic lateral sclerosis (ALS; 1229 data points). Trials with de\u2010meaned root mean squared (RMS) EMG amplitude of &gt;10\u00a0\u00b5V throughout the 200\u00a0ms prior to stimulation were rejected. Generalised linear mixed\u2010effects models assessed effects of muscle activity below this rejection threshold on the probability of evoking an MEP with peak\u2010to\u2010peak amplitude of \u226550\u00a0\u00b5V. Greater sub\u2010rejection\u2010threshold activity significantly increases MEP probability in control subjects and people with ALS. Models predicted a 38%\u201343% increase in MEP probability when baseline RMS\u2010EMG amplitude increased from  to 9\u00a0\u00b5V. Sub\u2010rejection\u2010threshold baseline activity was significantly greater in ALS than control subjects. Below a typical rejection threshold, greater baseline RMS\u2010EMG amplitudes markedly increase the probability of evoking MEPs with peak\u2010to\u2010peak amplitude of \u226550\u00a0\u00b5V. Effects of sub\u2010rejection\u2010threshold muscle activity should be accounted for when comparing RMT measures, particularly between cohorts where such activity differs, such as ALS and control subjects.<\/jats:p>","DOI":"10.1113\/ep093429","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T04:36:59Z","timestamp":1783312619000},"page":"3492-3501","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Very low\u2010amplitude muscle activity increases probability of motor evoked potentials in healthy individuals and in amyotrophic lateral sclerosis"],"prefix":"10.1113","volume":"111","author":[{"given":"S\u00e9amus","family":"O'Sullivan","sequence":"first","affiliation":[{"name":"Discipline of Physiology, School of Medicine, Trinity College Dublin The University of Dublin  Dublin 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