• 18-80 years of age inclusive

• Sporadic or familial ALS diagnosed as clinically possible, probable, lab-supported probable, or definite ALS as defined by revised El Escorial criteria

• Less than or equal to 3 years since ALS symptom onset

• Slow Vital Capacity ≥ 50% of predicted capacity at the time of Screening as determined using a portable spirometer

• For TMS: a resting motor threshold, (defined as the minimum intensity to elicit a motor evoked potential (MEP) of amplitude ≥ 50 μV from at least 5 of 10 consecutive pulses)

• For TTNCS: Median CMAP ≥ 1.5 mV

• Willing to forgo botulinum toxin, phenol or alcohol injections, intrathecal baclofen, digitalis, and morphine for the study duration

• Willing to refrain from participation in any other therapeutic clinical trial or investigational product for ALS for the duration of this study

• Women must not be able to become pregnant (e.g., post-menopausal, surgically sterile, or using adequate birth control methods) for the duration of the study and 3 months after study completion.

⁃ Stable dose of rilutek (Riluzole), edaravone (Radicava), or tofersen (Qualsody) and oral medications for muscle spasms/cramps (e.g. mexiletine, quinine, quinidine, magnesium, gabapentin, oxcarbazepine, baclofen) for at least 30 days prior to the onset of participation in the study

⁃ ALS Functional Rating Score (ALSFRS-R) of greater than or equal to 35

⁃ Willing and able to give informed consent