what are symptoms of als

Amyotrophic lateral sclerosis (ALS) usually starts with subtle muscle problems and then gradually affects movement, speech, swallowing, and breathing over time.

Common early symptoms

These often begin in one limb (an arm or a leg) or with speech and swallowing.

• Muscle weakness in a hand, arm, foot, or leg (e.g., trouble turning a key, buttoning a shirt, lifting objects).

• Frequent tripping, stumbling, or difficulty walking or running.

• Hand clumsiness, dropping things, trouble with writing or fine finger movements.

• Muscle twitches (fasciculations) under the skin, often in arms, legs, shoulders, or tongue.

• Muscle cramps and stiffness or tightness (spasticity) in affected muscles.

• Slurred, “thick,” or quieter speech, or changes in voice tone or pitch.

• Difficulty swallowing, choking on liquids, or coughing when eating or drinking.

• Unusual fatigue and feeling physically exhausted more easily than before.

Later or progressive symptoms

As ALS advances, weakness spreads and more functions become affected.

• Worsening muscle weakness and visible muscle wasting (atrophy) in arms, legs, shoulders, and trunk.

• Increasing difficulty walking, standing, using hands, or performing daily activities; more frequent falls.

• Marked stiffness and exaggerated reflexes (spasticity, hyperreflexia) from upper motor neuron involvement.

• More pronounced muscle cramps and constant or frequent fasciculations.

• Significant trouble speaking (dysarthria) and swallowing (dysphagia).

• Trouble breathing, shortness of breath with activity or when lying flat, eventually needing breathing support.

• Paralysis of most voluntary muscles in advanced stages.

Emotional, thinking, and behavior changes

Not everyone experiences these, but they can occur in ALS.

• Involuntary or inappropriate laughing or crying (pseudobulbar affect). People may cry or laugh suddenly, without feeling especially sad or happy.

• Changes in thinking, planning, or behavior in some patients, occasionally overlapping with frontotemporal dementia.

Important clarifications

• ALS typically does not affect the senses of sight, hearing, smell, taste, or touch, and bladder/bowel function is usually preserved.

• Many of these symptoms are common and can be caused by many other, more benign conditions; having one or a few of them does not mean you have ALS.

When to seek medical help

• See a doctor promptly if you notice persistent, progressive muscle weakness, especially if it spreads from one area to another or is accompanied by speech or swallowing difficulties.

• A neurologist (ideally with neuromuscular expertise) is usually the specialist who evaluates for ALS and rules out other causes.

This information is for general education and not a diagnosis. If you are worried about your own symptoms, please contact a healthcare professional as soon as you can.

Information gathered from public forums or data available on the internet and portrayed here.