Clinical Neurophysiology Journal - Editor's Choice

Professor Robert Chen
Editor-in-Chief,
Clinical Neurophysiology

The Editor’s Choice | October 2026

Each month, Robert Chen, Editor-in-Chief of Clinical Neurophysiology, selects an Editor's Choice article highlighting noteworthy research from the latest issue, along with additional Editor's Choice highlights.

Cortical changes in amyotrophic lateral sclerosis: comparing biomarkers of glymphatic flow and cortical excitability

Clinical Neurophysiology Volume 190 

Nathan Pavey, Sicong Tu, Sheryl Foster, Nimeshan Geevasinga, Aicee Calma, Yukiko Tsuji, Matthew C. Kiernan, Steve Vucic, Parvathi Menon

The glymphatic system plays an important role in removal of toxic and metabolic waste from the brain, and its dysfunction have been implicated in neurodegenerative diseases such as Alzheimer’s disease and amyotrophic lateral sclerosis (ALS). Cortical hyperexcitability may play a role in the pathophysiology of ALS. In this volume of Clinical Neurophysiology, Pavey et al. measured glymphatic function using diffusion weighted MRI and cortical excitability using transcranial magnetic stimulation in 35 ALS patients and 25 age-matched controls. The authors found reduced glymphatic function and cortical hyperexcitability in ALS patients. Glymphatic function correlated with cortical silent period duration, a measure related to GABA_B-mediated cortical inhibition. The findings raised the intriguing possibility that cortical hyperexcitability in ALS could be related to impaired glymphatic function.