Early ALS Symptoms

ALS can present itself in a variety of ways. Early symptoms may be subtle enough that they are initially overlooked, ignored, or attributed to something else. But as ALS symptoms progress, they gradually begin to affect day-to-day activities.

Limb Onset ALS

Roughly two-thirds of ALS cases begin in one of the limbs—often in a hand or a foot. The most common symptom is muscle weakness without any pain. ALS usually progresses throughout one limb before spreading to another.

Early signs of limb onset may include:

  • Muscle weakness without pain
  • Muscle stiffness
  • Difficulty walking, including tripping
  • Difficulty with daily tasks, like buttoning a shirt
  • Involuntary jerking of a limb
  • Muscle cramping and twitching
Muscle twitching, also called fasciculations, is a symptom of ALS, but it is usually not the first thing people notice. Many people experience benign muscle twitching at some point in their lives and never have ALS.

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Bulbar Onset ALS

In roughly one-third of cases, ALS begins by affecting the muscles that control speaking and swallowing.

Early signs of bulbar onset ALS may include:

  • Slurred speech
  • Difficulty swallowing
  • Choking on liquids
  • Hoarseness
  • Drooling
  • Episodes of uncontrollable laughing or crying

Respiratory Onset

ALS can affect the respiratory muscles first, though this is relatively rare. The primary symptom of respiratory onset is shortness of breath.

Cognitive and behavioral changes

For some, ALS can also affect the mind. Cognitive and behavioral changes usually develop after physical symptoms, but in some cases they may appear first. Signs can include acting out of character, lack of motivation, and irritability. Learn more about frontotemporal dementia.

What if I'm worried I might have ALS?

If you are experiencing any of the symptoms listed above, it does not mean you have ALS. Your symptoms may have another explanation. Either way, it is important to be proactive and find the cause of your symptoms so you can begin to receive the right type of care and support as soon as possible.
Start by making an appointment with a local neurologist, who can do an initial EMG test to check for any muscle or nerve issues. If ALS is still a possibility after your test, and if your neurologist doesn’t specialize in ALS, you will want to schedule an appointment with an ALS neurologist for followup testing.

Ask your current neurologist or local ALS organization for recommendations. You can also visit our ALS Clinics Directory to locate a clinic near you and schedule an appointment.