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This phenomenon was evaluated in human patients by investigating changes in motor unit firing during contraction and relaxation. Twenty\u2010two ALS patients with subtle motor deficits and 28 controls performed tonic contractions of extensor carpi radialis, triceps brachialis, tibialis anterior and quadriceps, aiming to isolate a low\u2010threshold unit (U1) on the electromyogram (EMG). Subsequently, they performed a stronger contraction or tendon vibration was delivered, to recruit higher threshold unit (U2) for 10\u00a0s before they relaxed progressively. EMG and motor unit potential analyses suggest altered neuromuscular function in all muscles, including those with normal strength (Medical Research Council score at 5). During the preconditioning tonic phase, U1 discharge frequency did not differ significantly between groups. During recruitment, the increase in U1 frequency (\u2206<jats:italic>F\u2010R<\/jats:italic>) was comparable between groups both during contraction and tendon vibration. During derecruitment, the decrease in U1 frequency (\u2206<jats:italic>F\u2010D<\/jats:italic>) was reduced in ALS regardless of the recruitment mode, particularly for \u2206<jats:italic>F\u2010R<\/jats:italic>\u00a0&lt;8\u00a0Hz in the upper limbs, consistent with the muscle weakness profile of the group. \u2206<jats:italic>F\u2010D<\/jats:italic> was associated with functional disability and its reduction was more pronounced in patients with more rapid disease progression rate. This <jats:italic>in vivo<\/jats:italic> study has demonstrated reduced motoneuron capacity for self\u2010sustained discharge, and further supports that motoneurons are normo\u2010 to hypoexcitable in ALS patients, similar to observations in experimental models.<\/jats:p><\/jats:sec>","DOI":"10.1113\/jp278117","type":"journal-article","created":{"date-parts":[[2019,9,16]],"date-time":"2019-09-16T06:39:18Z","timestamp":1568615958000},"page":"5445-5467","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Absence of hyperexcitability of spinal motoneurons in patients with amyotrophic lateral sclerosis"],"prefix":"10.1113","volume":"597","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0226-7169","authenticated-orcid":false,"given":"V\u00e9ronique","family":"Marchand\u2010Pauvert","sequence":"first","affiliation":[{"name":"Sorbonne Universit\u00e9 Inserm, CNRS, Laboratoire d'Imagerie Biom\u00e9dicale LIB  Paris 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