Symptoms typically occur with gradual onset and most patients will first notice mild weakness in the arms and/or legs. Weakness in the arms may cause difficulties with tasks requiring dexterity such as buttoning up a shirt or turning a key in lock. Lower limb weakness may cause difficulties with walking, problems stumbling, tripping or lifting the foot when walking.
A small percentage of patients may first notice changes in their speech and/or swallowing and this is known as bulbar onset. Weakness in the muscles of the throat and face can lead to difficulties speaking clearly and problems swallowing.
In ALS people may notice their muscles appear wasted known as atrophy, and some people may experience twitching of the muscles known as fasciculation or stiffness and cramps.
Eventually weakness spreads to other muscles of the body, the rate of progression will vary but as the disease advances people with ALS will have difficulties with basic tasks such as walking, rising from a chair, getting in and out of bed and feeding leading to loss of independence. Cognitive function such as memory or intelligence is usually but not always spared as is bladder and bowel function and sense of smell, touch, taste or hearing. Weakness affecting the muscles controlling respiration may cause difficulties breathing and patients may require breathing support.
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