The onset of amyotrophic lateral sclerosis (ALS) can be so subtle that the symptoms may go unnoticed. However, these symptoms gradually develop into more obvious muscle weakness or atrophy. Some of the early signs and symptoms of ALS include:

  • Difficulty walking or doing your normal daily activities
  • Tripping and falling
  • Stiff and tight muscles (spasticity)
  • Muscle weakness in the leg, feet, or ankles
  • Hand weakness or clumsiness
  • Slurred speech
  • Trouble swallowing
  • Muscle cramps and twitching in the arms, shoulders, and tongue
  • Difficulty holding the head up or maintaining a good posture

The parts of the body exhibiting early signs of ALS depend on which muscles are being affected.

For many patients, the first symptoms of ALS may appear in the hands or arms and they may have trouble with simple tasks requiring manual dexterity such as writing, buttoning a shirt, or turning a key in a lock.  In other patients, symptoms may affect one leg initially, with people experiencing clumsiness when they walk or run, or they may notice they are tripping or stumbling more often. This normally is termed as “limb onset” ALS.

For other patients, the initial signs of the disease may include speech or swallowing problems, often referred as “bulbar onset” ALS.

As the disease progresses and nerve cells are destroyed, the muscles progressively weaken. This eventually affects chewing, swallowing, speaking, and breathing more severely. As the respiratory system weakens, patients eventually lose the ability to breathe on their own and may need to use a ventilator.

Besides muscle cramps that may cause discomfort, some ALS patients may develop painful neuropathy (nerve disease or damage). ALS patients also are at an increased risk of developing pneumonia especially during later stages of the disease.

Usually, ALS does not affect bowel or bladder control, the senses, and thinking ability, so patients can remain actively involved with their family and friends. However, some individuals may experience problems with language or decision-making, and there is growing evidence suggesting that as the disease progresses some patients may develop a form of dementia.

Currently, there is no single test that can provide a definitive diagnosis of ALS, but the presence of both upper and lower motor neuron symptoms strongly suggests that someone may have the disease. The diagnosis of ALS is primarily based on the signs and symptoms a doctor observes in the patient and tests that rule out other diseases.

ALS News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.