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Split-hand and split-limb phenomena in amyotrophic lateral sclerosis: pathophysiology, electrophysiology and clinical manifestations
  1. Philippe Corcia1,
  2. Peter Bede2,3,
  3. Pierre-François Pradat4,5,
  4. Philippe Couratier6,
  5. Steve Vucic7,8,
  6. Mamede de Carvalho9,10
  1. 1Centre Constitutif de Référence SLA, CHU Bretonneau, Tours, France
  2. 2Computational Neuroimaging Group, Trinity College Dublin, Ireland
  3. 3Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France
  4. 4Neurology, Hopital Pitie-Salpetriere, Paris, France
  5. 5LIB, Université Pierre et Marie Curie Faculté de Médecine, Paris, Île-de-France, France
  6. 6Centre Constitutif de Référence SLA, CHU de Limoges, Limoges, France
  7. 7Westmead Clinical School, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
  8. 8Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
  9. 9Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisbon, Lisbon, Portugal
  10. 10Department of Neurosciences and Mental Health, Hospital de Santa Maria, Lisboa, Portugal
  1. Correspondence to Professor Philippe Corcia, ALS Center, Université de Tours Faculté de Médecine, Tours, Centre-Val de Loire, France; corcia{at}


Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting the upper and lower motor neurons. A key clinical feature of ALS is the absence of accurate, early-stage diagnostic indicators. ‘Split-hand syndrome’ was first described in ALS at the end of the last century and a considerable body of literature suggests that the split-hand phenomenon may be an important clinical feature of ALS. Considering the published investigations, it is conceivable that the ‘split-hand syndrome’ results from the associated upper and lower motor neuron degeneration, whose interaction remains to be fully clarified. Additionally, other split syndromes have been described in ALS involving upper or lower limbs, with a nuanced description of clinical and neurophysiological manifestations that may further aid ALS diagnosis. In this review, we endeavour to systematically present the spectrum of the ‘split syndromes’ in ALS from a clinical and neurophysiology perspective and discuss their diagnostic and pathogenic utility.

  • motor neuron disease
  • neurophysiol
  • clinical
  • clinical neurology

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  • Correction notice This article has been corrected since it appeared Online First. Author affiliations for Peter Bede have been corrected.

  • Contributors All authors contributed equally to the inception and drafting of this review paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.