Early symptoms associated with ALS

Early Symptoms Associated with ALS

The initial symptoms of ALS can vary from individual to individual but often include muscle weakness, twitches, muscle cramps and slurred speech.

Amyotrophic Lateral Sclerosis (ALS) is a debilitating neurodegenerative disease that damages the nerves in the body causing muscle weakness and eventual paralysis.

Most cases of ALS occur between the ages of 40 and 70 but there are also individuals who have been diagnosed in their 20s. One of the most famous of these was Professor Stephen Hawking who lived for nearly 50 years with the disease.

Here we take a closer look at some of the early symptoms of ALS.

Muscle Weakness

The primary symptom many people experience when they have ALS is weakness in their muscles. The disease works by damaging the nerves that send signals to and from the brain and to the rest of the body.

Weakness can appear in a localized area and then gradually spread as the disease worsens and the nerves begin to die. For example, as the nerves become damaged, they are unable to send messages to the muscles to contract and facilitate movement.

Muscle Twitches

In addition to muscle weakness, individuals may experience a connected symptom which is known as fasciculation or muscle twitching. This occurs when the nerve serving a muscle is damaged so that the message is altered in some way or not complete. It can occur at night and affect sleep but is generally not painful.

Muscle weakness and spasticity (where muscles move involuntarily) are generally the most commonly noted early symptoms associated with ALS, occurring in about 80% of all cases.


ALS patient with muscle cramps

This is characterized by a sudden and painful contraction of the muscles causing cramping. Whilst not rare in ALS patients in general, it doesn’t often occur so much in the very early stages of the disease.

Slurred Speech

About 20% of people diagnosed with ALS will show early signs of slurred or disrupted speech. A lot depends on the areas that the disease affects in the body first. In most cases ALS begins in one, localized area and will then spread to other places as the condition becomes progressively worse.

Speech is controlled by many different muscle groups and damage to the nerves that serve these muscles can have a range of effects, including slurred speech. Individuals diagnosed with ALS may also have difficulty maintaining tone or notice that the strength of their voice becomes diminished.

Shortness of Breath

ALS patient with breathing difficulties

Shortness of breath and other issues with breathing can occur in individuals with ALS as certain muscle groups involved in the respiratory process become affected by the disease. However, this is often a symptom that occurs later on in the ALS progression timeline and is generally the first sign that the lungs are being affected by the disease.

Hand or Leg Weakness

The most common areas where muscle weakness shows in people with ALS is in the hands or the legs. For example, the individual might suddenly find that it’s difficult to fasten buttons on their shirt or there is no longer the fine movement with the fingers that used to be there.

Balance Issues

In the very early stages of ALS, there may also be balance issues due to muscle weakness in the legs. Some people may have trouble staying steady on their feet and might even fall or trip over more regularly.

Individuals that are diagnosed with ALS may not be aware that there is a significant problem during the early stages of the disease. To begin with, symptoms can be mild and easily ignored. Weakness in the arms or the legs might be solved initially by a little exercise. A trip or fall may be considered as a simple accident, rather than anything to do with a serious health condition.

It’s usually only when the symptoms either get worse or new ones begin to appear that people will head to their physician to have a check-up. In the very early stages, it can also be difficult to diagnose ALS as many of the symptoms are also associated with other conditions.

Slurred speech or dysarthria occur in other illnesses such as heart problems and brain injuries. Muscle weakness may indicate anything from chronic fatigue syndrome to concussion or spinal damage.

The fact that this disease shares symptoms with several less serious health issues can cause delays in an accurate ALS diagnosis taking place.