The early signs of ALS are easy to brush off: a weaker grip, a stumble on the stairs, muscle twitches that won’t settle. Most of the time, symptoms like these have far more common causes. But because ALS gets worse over time, it helps to know what to watch for and when to see a doctor.
This guide explains what ALS is, the early symptoms, who is most at risk, how doctors diagnose it and what treatment can do.
Key takeaways
- Early signs of ALS often start in one area, such as a weak grip or trouble climbing stairs, or with slurred speech or trouble swallowing.
- Most people learn they have ALS between ages 55 and 75, and about 5% to 10% of cases run in families.
- There’s no cure yet, but medicines can slow symptoms, so see a doctor about weakness that keeps getting worse.
What are the early signs of ALS?
The early signs of ALS usually involve muscle weakness that slowly gets worse. You might drop things, trip, find stairs harder, or notice muscle twitches and cramps. For some people, the first signs are slurred speech or trouble swallowing. These symptoms have many other causes, so only a doctor’s exam can tell what’s behind them.
What is ALS?
ALS (amyotrophic lateral sclerosis) is a disease that affects the nerve cells in both the upper and lower parts of the body, according to the CDC. These are the motor nerve cells that tell your muscles what to do. In the UK, the NHS calls the group of conditions motor neurone disease (MND), and ALS is its most common type.
When these nerve cells stop working, muscles get weaker over months or years. MedlinePlus notes that ALS doesn’t affect the senses, and most people keep thinking clearly, although some develop dementia or changes in behavior.
Early signs of ALS to watch for
Weak or stiff hands
The NHS lists problems holding or gripping things as an early sign. You might drop cups, struggle with buttons or find it hard to turn a key.
Weak legs and feet
Climbing stairs may get harder, or you may trip more often. MedlinePlus mentions trouble with routine tasks like climbing steps.
Muscle twitches, cramps or spasms
Twitches or cramps that keep happening, last a long time or don’t go away are worth a doctor’s visit, says the NHS.
Clumsiness
MedlinePlus lists reduced muscle strength and coordination among the early signs.
Slurred speech
In one type of MND, the first problems are slurred speech and difficulty swallowing, the NHS says.
Trouble swallowing
For some people, weakness first affects swallowing, according to MedlinePlus.
Shortness of breath
Less often, weakness first affects the muscles used for breathing, MedlinePlus notes.
Early signs of ALS at a glance
| Early sign | What you might notice | Source |
|---|---|---|
| Weak hands | Dropping things, trouble gripping | NHS |
| Weak legs or feet | Tripping, stairs feel harder | NHS, MedlinePlus |
| Twitches or cramps | Twitching or cramping that keeps coming back | NHS, MedlinePlus |
| Clumsiness | Less strength and coordination | MedlinePlus |
| Slurred speech | Words sound unclear | NHS |
| Swallowing problems | Coughing or choking when eating or drinking | MedlinePlus |
| Breathing problems | Shortness of breath | MedlinePlus |
Many people have one or two of these for ordinary reasons, like a nerve injury, tiredness or stress. What stands out in ALS is weakness that slowly spreads and keeps getting worse.
How ALS changes over time
MedlinePlus says more muscle groups are affected as the disease gets worse. Later ALS symptoms can include difficulty walking and breathing, swallowing problems, slurred speech, voice changes and trouble holding the head up.
Who gets ALS?
The CDC says reports suggest fewer than 30,000 people in the United States have ALS. It’s slightly more common in men than women, and most people find out they have it between ages 55 and 75. In the CDC’s registry data, ALS was more common among white, male, non-Hispanic people and people aged 60 to 69.
About 5% to 10% of ALS cases run in families, according to the CDC. MedlinePlus also lists older age, being male, toxin exposure, strenuous activity, traumatic brain injury and military service as risk factors.
How ALS is diagnosed
There’s no single test. MedlinePlus says a doctor will examine you and ask about your symptoms and history. Tests may include blood tests, breathing tests, brain or neck imaging, electromyography (EMG), genetic tests, swallowing studies and a spinal tap.
The NHS says your doctor may refer you to a neurologist, and that tests also help rule out other conditions. ALS can be hard to diagnose early, so it can take time to get a clear answer.
Treatment and outlook
There’s no cure yet. MedlinePlus says three medicines can slow symptoms: riluzole, edaravone and tofersen, which is used for one specific inherited form. Other care helps with stiffness, saliva, mood, eating, breathing and getting around, often from a team of specialists.
The CDC says most people live 2 to 5 years after ALS symptoms start. MedlinePlus adds that about 1 in 4 people live more than 5 years, and some live much longer.
When to see a doctor
See a doctor if you notice:
- difficulty holding or gripping objects
- weakness in your legs or feet
- twitches or muscle cramps that keep happening, last a long time or don’t go away
- any of these symptoms if ALS runs in your family
MedlinePlus says that more trouble swallowing, difficulty breathing or pauses in breathing need immediate attention. Call 911 or your local emergency number if someone is struggling to breathe.
Frequently asked questions
What is the age of onset for ALS?
Most people find out they have ALS between ages 55 and 75, according to the CDC. MedlinePlus says ALS symptoms usually don’t start until after age 50, but they can begin in younger people.
Can you have ALS for years and not know?
Early signs can be mild and easy to put down to other causes, and the NHS says ALS can be difficult to diagnose in the early stages. The weakness usually gets worse over months or years, so see a doctor if symptoms keep spreading or worsening.
Who is at highest risk for ALS?
Having a family member with an inherited form of ALS is a risk factor. MedlinePlus also lists older age, being male, toxin exposure, strenuous activity, traumatic brain injury and military service. Most people with ALS have no known family history.
Is ALS hereditary?
Sometimes. The CDC says about 5% to 10% of ALS cases occur within families, and MedlinePlus says about 1 in 10 cases is due to a genetic variant. In most other cases, the cause is unknown.
Do muscle twitches mean ALS?
Usually not. Muscle twitches are common and have many causes. The NHS suggests seeing a doctor if twitches or cramps keep happening, last a long time or don’t go away, especially alongside weakness.
Is ALS always fatal?
There’s no cure yet. The CDC says most people live 2 to 5 years after ALS symptoms start, but MedlinePlus says about 1 in 4 live more than 5 years and some live much longer. Medicines and specialist care can slow symptoms and help quality of life.
The bottom line
The early signs of ALS are usually muscle weakness that slowly spreads and gets worse, such as a weak grip, tripping, twitching, slurred speech or trouble swallowing. These symptoms often have other causes, but weakness that keeps getting worse deserves a doctor’s exam. Treatment can slow ALS, so it helps to get checked early.
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