Patterns of altered in vivo brain metabolism in patients with amyotrophic lateral sclerosis (ALS) and asymptomatic C9orf72 mutation carriers: a cross-sectional <sup>1</sup>H and <sup>31</sup>P magnetic resonance spectroscopic 7T imaging study.

1 , 32 Our study is in accordance with these findings, but because our 1 H MRSI slices were perpendicular to the motor regions, resulting in a relatively small sample from the entire motor region, and because of our correction for multiple comparisons, the reduction in level of tNAA/tCr did not reach statistical significance. 1 , 32 Furthermore, the neuronal dysfunction is more severe in C9+, which could be a source of bias in previous MR(S)I studies that did not analyse the effect of C9 status.

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