Individualized Functional Imaging-Guided Repetitive Transcranial Magnetic Stimulation (rTMS) for Treating Postural Gait Disorders in Patients with Amyotrophic Lateral Sclerosis (ALS): a Randomized, Crossover, Controlled, Double-Blind Clinical Study

The Berg Balance Scale (BBS) assesses static and dynamic balance. The scale ranges from 0 to 56, with higher scores indicating better balance and lower scores signifying greater fall risk.

Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) Total Score(ALSFRS-R total score).The ALSFRS-R evaluates functional impairment in ALS patients. The total score ranges from 0 to 48, with higher scores reflecting better functional ability.

Walking and stepping sub-items, Modified Ashworth Scale (MAS),The scale ranges from 0 to 4, with higher scores indicating greater spasticity.

Timed Instant Walking (TUG) tes,the TUG test measures mobility and fall risk. Lower times indicate better mobility.

10-meter walking test time (10MWT),This test measures walking speed over a 10-meter distance. Lower times indicate faster walking speed

Functional MRI (fMRI) - Brain Function and Cortical Excitatory Changes, fMRI will assess changes in brain function and cortical excitability.Functional MRI (fMRI) is a neuroimaging technique used to assess brain function by detecting changes in blood oxygen levels (BOLD signal), which reflect neural activity. In this study, fMRI will be used to evaluate brain function and cortical excitability in patients with schizophrenia. Specifically, it will assess neural activation patterns in response to cognitive and emotional tasks designed to probe social cognition, emotion recognition, and executive functions. Areas of interest include the prefrontal cortex, amygdala, and visual processing regions involved in emotion processing and decision-making.fMRI will be performed as follows:Participants will be scanned while completing emotion recognition tasks to identify brain regions activated during these tasks.Scans will be conducted in a resting-state condition as well, to measure baseline cort

Gait Assessment and Fall Index (Tetrax Instrument),Gait and fall risk assessment will be conducted using the Tetrax instrument. Data will be analyzed as index. The Fall Index Assessment is conducted using the Tetrax instrument, which is a widely used device for evaluating balance and fall risk. The Tetrax system consists of a set of sensors placed on the patient's feet to measure their ability to maintain balance in various postural positions, including static (standing still) and dynamic (movement) tasks. The system evaluates several components of balance, including:Postural Sway: The extent of body movement while standing;Stability: The ability to maintain a balanced posture under different conditions;Response Time: How quickly the subject can correct their posture after perturbation (e.g., slight push)；Foot Pressure Distribution: How evenly weight is distributed between the feet while standing.

Neurofilament protein (NFL),NFL levels will be measured in blood samples to assess neurodegeneration.Neurofilament light chain (NFL) is measured in peripheral blood samples using the SIMOA (Single Molecule Array) assay, a highly sensitive technique that quantifies NFL levels at the single-molecule level. NFL concentration is expressed in pg/mL, with higher levels indicating greater neuronal injury or neurodegeneration.