What are the symptoms of amyotrophic lateral sclerosis?
ALS patients can have different symptoms, or a different progression of symptoms. The universal symptom is muscle weakness and eventual paralysis. Early symptoms of ALS are often overlooked or ignored because they’re so subtle. Symptoms can include some or all of these:
- Muscle twitches or cramps in an arm, leg, shoulder or tongue
- Tight or stiff muscles
- Muscle weakness in an arm, leg, neck or diaphragm (breathing muscles)
- Slurred speech
- Hand weakness or clumsiness; problems with simple hand movements such as dressing or writing
- Problems chewing or swallowing
- Awkwardness when walking or running; may trip or stumble more often
- Inappropriate crying, laughing or yawning
- Behavioral changes
More advanced symptoms occur when muscle atrophy and weakness spread to other parts of the body. Weakness, atrophy and muscle paralysis of the limbs and trunk, and those that control speech, swallowing and breathing continue to get worse. These symptoms include problems with:
- Movement
- Swallowing (dysphagia)
- Forming words and speaking (dysarthria)
- Breathing (dyspnea)
Advanced ALS symptoms include:
- Unable to stand or walk
- Unable to get in and out of bed without help
- Unable to use their arms and/or legs
- Difficulty eating and swallowing; most patients lose weight rapidly because they burn calories quickly and can become malnourished
- Unable to breathe without a mechanical ventilator (breathing machine)
- Some patients develop frontotemporal dementia over time, although this symptom is rare
- Risk of pneumonia increases
- Muscle cramps
- Painful nerve disease or damage (neuropathy)
The progression of ALS is inevitable but not always at a constant rate. Many patients have weeks to months where there is very little or no additional loss of function. Some patients show improvement and recover lost function, but this is rare. These reversals do not last; it’s rare that improvement in function lasts longer than a year.
People with ALS do not lose their mental capacity (cognitive function) to reason, remember, understand and solve problems. Their senses remain intact and pain is uncommon. They are very aware of their increasing physical deficits, and inability to live independently. Because of the increasing losses they are experiencing, it is common to become depressed or anxious.
