Majid Ghasemi - Department of Neurology, Isfahan Neuroscience Research Center, Isfahan University of Medical Science, Isfahan, Iran.
Maryam Alizadeh - Department of Neurology, Isfahan Neuroscience Research Center, Alzahra Research Institute, Isfahan University of Medical Science, Isfahan, Iran.
Keyvan Basiri - Department of Neurology, Isfahan Neuroscience Research Center, Alzahra Research Institute, Isfahan University of Medical Science, Isfahan, Iran.
Behnaz Ansari - Department of Neurology, Isfahan Neuroscience Research Center, Alzahra Research Institute, Isfahan University of Medical Science, Isfahan, Iran.
Reza Tayebi Khorami - Department of Mathematics , Ahvaz Branch , Islamic Azad University , Ahvaz , Iran.

Background: We aimed to assess the diagnostic utility of abductor pollicis brevis/abductor digiti minimi compound muscle action potentials (APB/ADM CMAP) ratio as an indicator of split hand phenomenon in the differentiation of amyotrophic lateral sclerosis (ALS) patients from healthy controls. Objectives: To assess diagnostic utility of APB/ADM CMAP ratio as an indicator split hand phenomenon in differentiation of ALS patients from healthy controls. Materials & Methods: This cross-sectional retrospective study was conducted at Alzahra and Kashani hospitals of Isfahan, Iran, in ۲۰۲۱. The study population consisted of all patients with definite diagnoses of ALS who had undergone electrophysiological studies within the previous ۵ years. APB/ADM CMAP ratio was calculated in both groups based on right/left hand and below/ over ۵۰ years of age. The statistical analysis also evaluated the diagnostic accuracy of the APB/ ADM amplitude ratio. Results: A total of ۲۰۰ ALS patients and ۲۰۰ healthy controls were evaluated. APB/ADM ratios of the right hand in the controls and patients were ۱.۲۷±۰.۷۱ and ۱.۲۷±۱.۶۹ (P=۰.۹۶۱), while in the left hand, these figures were ۱.۳۰±۰.۵۴ and ۱.۱۱±۰.۹۷, respectively (P=۰.۰۱۸). Analysis based on age group revealed a significant difference in the APB/ADM amplitude ratio in the left hand of individuals younger than ۵۰. The cut-off points of ۰.۸۱ (sensitivity=۸۶.۲% and specificity=۵۸.۷%) and ۱.۰۳ (sensitivity=۷۲.۵% and specificity=۵۸.۵%) were calculated for right and left hands, respectively. Conclusion: APB/ADM CMAP ratio is a relatively highly sensitive but moderately specific diagnostic marker for differentiating ALS patients from healthy controls with higher diagnostic utility in patients younger than ۵۰.

Muscle atrophy, Amyotrophic lateral sclerosis, Split hand