Symptoms of ALS

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive neurodegenerative disease that affects motor neurons or nerve cells controlling muscle movement.

Symptoms of ALS can occur at any age but usually begin around ages 55 to 75 and progress gradually. Muscles involved in speech and swallowing are generally affected first, followed by muscles in hands and legs, although the sequence of the emergence of symptoms can vary from person to person.

A definite diagnosis of ALS is not possible so the disease is usually confirmed after eliminating the possibility of other neurological disorders.

Depending on the stage of disease progression, ALS symptoms may range from mild to severe.

Early-stage symptoms

Early-stage symptoms are mild and typically affect the muscular system. Muscle weakness is common, affecting the patient’s ability to walk, speak, and chew food. Swallowing and breathing often become difficult as well. Muscular symptoms include twitches (fasciculation), fatigue, cramps, stiffness (spasticity), and unintentional weight loss.

As a result of muscle weakness, patients may experience poor balance or tripping while walking and difficulty grasping objects with a tight grip. Some of these muscular symptoms might occur before diagnosis or could be due to other neurological complications as well.

Mild digestive symptoms are also seen in some ALS patients. These include constipation, cramping, bladder urgency, and delayed gastric emptying. Since these symptoms are mild, they are often not immediately noticed or attributed to ALS.

Mid-stage symptoms

In the mid-stages of the disease, symptoms gradually worsen with increased muscle weakness. Paralysis may also be observed. Infrequently used muscles tend to get shortened (contractures), and joints may not fully straighten. Difficulties swallowing, breathing, and speaking are observed due to the weakening of mouth, throat, and chest muscles.

Some patients may also experience a rare condition called the pseudobulbar effect characterized by sudden and brief bouts of laughter or tears for no reason.

Late-stage symptoms

As the disease continues to progress, almost all muscles of the body become paralyzed. Breathing becomes increasingly difficult, and patients usually require a ventilator. Respiratory failure is one of the primary causes of death in ALS patients.

A feeding tube usually becomes necessary due to extreme difficulty chewing or swallowing. Other fatal symptoms such as pulmonary embolism (blood clot in a lung artery) and heart arrhythmias (irregular heartbeat) may also be observed in some patients at this stage.

ALS patients usually retain their mental reasoning, thinking, and sensory abilities, and are aware of their progressive loss of motor function. This makes them prone to anxiety and depression, leading to changes in appetite, sleep, or even suicidal tendencies. Some patients also develop a form of dementia at this stage.


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.