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Disruptions in energy homeostasis and metabolism emerge in ALS and are considered central to disease pathogenesis 11,12

However, it did not reduce them after the onset, as in the control group

Oxidative stress reactions, particularly the excessive generation of reactive oxygen species (ROS), may interfere with the function of the hypothalamic-pituitary-adrenal (HPA) axis, leading to hormonal imbalances that impact sleep and physical stamina (Spiers et al., 2015)