Weakness in the legs, feet, or ankles can make walking more difficult. A person may begin tripping over objects, stumbling, or falling more often than usual.
Difficulty performing ordinary daily activities can also occur as weakness progresses.
3. Hand Clumsiness
Early ALS can sometimes begin in the hands.
A person may notice that they are dropping objects, struggling with buttons or zippers, having difficulty writing, or finding familiar hand movements unusually difficult.
4. Muscle Twitching and Cramps
Small involuntary muscle movements, known as fasciculations, can occur in ALS. Muscle cramps may also develop.
However, muscle twitching by itself is extremely common and can have many causes. It does not automatically indicate ALS. In ALS, twitching is more concerning when it occurs alongside progressive, objective muscle weakness.
5. Slurred Speech
When ALS affects the muscles involved in speaking, a person’s speech may become slower, weaker, or slurred.
Some people may also notice changes in their voice or difficulty controlling the muscles of the tongue and mouth.
6. Difficulty Swallowing
Another possible early symptom is difficulty swallowing food or liquids.
A person may cough while eating or drinking, feel that food is getting stuck, or have increasing difficulty controlling food in the mouth.
7. Changes in Walking and Coordination
As weakness develops, everyday movements may become increasingly difficult.
Someone who previously walked normally might begin having trouble with balance, climbing stairs, standing from a chair, or performing familiar physical tasks.
What ALS Usually Does Not Cause Early On
ALS primarily affects motor nerve cells. It generally does not cause problems with the senses such as hearing, taste, smell, or touch, and pain is not usually a prominent early symptom. Bladder function is also generally preserved.
This is one reason why a combination of progressive muscle weakness and other motor symptoms can be more concerning than an isolated symptom such as occasional twitching.
When Should You See a Doctor?
If you develop persistent or progressively worsening muscle weakness, repeated unexplained falls, increasing hand clumsiness, slurred speech, or difficulty swallowing, make an appointment with a healthcare professional.
A neurologist may be involved if a neurological condition is suspected. There is no single test that confirms ALS immediately. Doctors typically evaluate the symptoms and neurological examination and may use tests such as electromyography (EMG) and nerve-conduction studies while also looking for other conditions that can produce similar symptoms.
Most importantly, don’t diagnose yourself based on an internet article or a single symptom. Muscle twitching, cramps, weakness, and numbness can have many different causes, and only a medical evaluation can determine what is happening.
If symptoms such as sudden weakness or sudden difficulty speaking develop abruptly, seek urgent medical attention, because sudden neurological symptoms can have causes other than ALS that require immediate treatment.
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