ALS (also referred to as Lou Gehrig's disease or MND) is a neurodegenerative disease that weakens muscles throughout the body. Early signs of ALS are different for everyone and can begin in different parts of the body. Regardless of how or where ALS first appears, the common symptom is the gradual, painless weakening of muscles.
Early ALS symptoms may be subtle enough that they are initially overlooked or attributed to something else, but as symptoms progress, they begin to affect day-to-day activities enough that they become difficult to ignore.

Limb Onset ALS

Roughly two thirds of ALS cases begin in one of the limbs—often in a hand or a foot. 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 and catching your foot on the ground
  • Difficulty with tasks that involve fine motor skills, like buttoning a shirt
  • Involuntary jerking of a limb
  • Muscle cramping
  • Muscle twitching​
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Muscle twitching, also called fasciculations, can be a symptom of ALS, but it is important to note that many people experience benign muscle twitching at some point in their lives that has nothing to do with ALS.

Bulbar Onset ALS

In roughly one third of all cases, ALS begins by affecting muscles around the lower face 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 begin by affecting respiratory muscles first, though this is rare. The primary symptom of respiratory onset is shortness of breath.

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 receiving appropriate care sooner rather than later.
You can start by scheduling an appointment with a local neurologist. If ALS is still a possibility after your visit—and if your neurologist doesn’t specialize in ALS—schedule an appointment with an ALS neurologist for follow-up testing.

Ask your general neurologist or local ALS organization for recommendations. You can also visit our ALS Clinics Directory to locate an ALS clinic in your area. Find out if you will need a referral in order to schedule an appointment.

How is ALS diagnosed?

ALS can be difficult to diagnose. There is no one definitive test, which means your neurologist may need to run a series of tests to rule out other diseases and conditions. Learn more
This page has been reviewed by ALS neurologist Dr. Terry Heiman-Patterson.