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The widespread and relentless progression of skeletal muscle weakness secondary to motor neuronal degeneration in amyotrophic lateral sclerosis (ALS) is all the more striking in the relative preservation of those motor neurons subserving oculomotor function and continence. The molecular and broader physiological basis for selective neuronal vulnerability in ALS remains a subject of intense study and speculation. We note significant similarities with the pattern of muscle involvement associated with rapid eye movement (REM) sleep, raising the possibility of shared motor networks and so novel avenues for study.
The stage of normal sleep associated with REM involves a temporary but profound state of motor paralysis during which there is, by definition, preservation of eye movements, and also continence. Respiration enters a more wakeful pattern of …
Footnotes
Twitter @AmmarAlChalabi
Contributors MRT and AA-C contributed equally to the conception and writing.
Funding MRT was funded by the Motor Neurone Disease Association (Walker Professorship).
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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