As the course of disease varies among patients, it is impossible to list symptoms common to all ALS patients. However, we can try to present a few categories of symptoms occurring in the initial stage of ALS. They are as follows:

  • movement impairment, e.g. dropping objects more frequently, tripping or falling over due to muscle weakness and partial atrophy or sometimes muscle stiffness,
  • speech difficulties,
  • occasional muscle cramping, e.g. in the calves,
  • noticeable partial atrophy of the muscles of hands, arms and legs, easily noticeable in the so called shoulder girdle i.e. shoulders, shoulder-blades and clavicles.
  • fasciculation, that is minor muscle twitching described by patients as a sensation of "worms crawling under the skin" occurring mainly in the hands.

The progress of the disease, as mentioned above, can be quite variable from one person to another. What is more, it is very difficult to diagnose ALS in the initial stage. Therefore, people who do not have their diagnosis confirmed do not have to be suffering from ALS, even if one or all of the above listed symptoms occur.

What are other symptoms?

initial symptoms
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ALS is progressive, which means that muscle weakening and atrophy gradually advance. A person unable to perform precise movements with his hand e.g. doing up his shirt, will not be able to cope with this task at all as the diseases progresses.

Walking more slowly due to more frequent falls may force the patient to use walking aids until a wheelchair is necessary for the patient's mobility. Muscle weakness may also cause difficulties in keeping the head in an upright position (a tendency for the head to fall forwards). Additionally, when trunk muscles are involved, the ALS patient may experience difficulties in sitting for a long time, turning in bed or sitting up from a recumbent position.

While the disease progresses, the speech may gradually become more slurred (nasal) until the patient loses the ability to communicate verbally altogether (some patients retain vestigial speech).

Muscle weakness and atrophy are usually accompanied by the so called spasticity, that is stiffness of the muscles experienced by patients trying to ,e.g., bend their legs and realizing that they struggle to do so because of an excessive tightness of the muscles. Patients with spastic muscles sometimes may develop contractures with time.

While the disease progresses, other symptoms directly or indirectly caused by ALS occur. In many cases, difficulty swallowing is often accompanied by excessive drooling, which is not only unpleasant for the patient for obvious reasons but also can be dangerous for him because an excess of saliva entering the affected oesophagus may result in choking. If the patient starts to choke more frequently, enteral feeding should be introduced.

Another symptom is connected with respiratory failure caused by insufficient work of respiratory muscles (e.g. diaphragm). It leads to increased fatigue (not to be confused with fatigue caused by muscle weakness), shortness of breath, headaches, nightmares (not to be confused with nightmares caused by depression and phobias), difficulties , hallucinations or disorientation in the case of extreme oxygen deficiency.

From the very onset of ALS, patients report unintended emotional reactions such as uncontrolled crying or laughter, which on no account are symptoms of mental disorders but indicate organic brain damage caused by ALS (symptoms of pseudobulbar syndrome).

initial symptoms
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Patients confined to bed with an impaired mobility due to progressing paralysis, may suffer from constipation mainly due to the fact that the digestive system cannot digest food while a person lies back without abdominal muscles' assistance in food mixing which work when the patient moves.

All the symptoms described above can be reduced or alleviate effectively. While ALS is still incurable, it does not mean that you have to succumb to it without a fight. In fact, it is quite the opposite. Doctors, physiotherapists and other medical experts are there to provide ASL patients with assistance. Thus, we recommend taking advantage of their knowledge and professional experience.

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