SOD1 and amyotrophic lateral sclerosis: MRS analysis of the cervical spinal cord of patients with ALS revealed a significant reduction in the NAA/creatinine (Cr) and NAA/Myo-inositol (Myo) ratios associated with disease progression.101,102 Notably, asymptomatic subjects carrying SOD1 mutations present analogous findings, indicating that these metabolic changes may precede disease onset.103