Amyotrophic Lateral Sclerosis – First, Early Symptoms of ALS

Amyotrophic lateral sclerosis (ALS) is a progressive disease of the nervous system in which motor nerve cells in the cerebral cortex and spinal cord are damaged. The disease belongs to the group of neurodegenerative diseases, which also includes such widespread and well-known diseases as Parkinson’s disease and Alzheimer’s disease.

ALS symptoms including early one

  • Twitching of muscles (fasciculations);
  • Muscle weakness and stiffness in the joints;
  • Muscle cramps and spasms;
  • Fatigue;
  • Pain;
  • Swallowing problems;
  • Saliva and phlegm;
  • Cough and choking feeling;
  • Breathing problems;
  • Problems with speech and communication;
  • Emotional lability (pseudo-bulbar effect);
  • Emotional reactions;
  • Violation of higher mental functions.

How to overcome first signs of als?

Muscle twitching (fasciculations)

What’s happening? Twitching and twitching sensations of muscles under the skin (fasciculations) are often the first and most annoying symptoms of ALS. In some people, they are localized in individual muscles, but they can spread over time.

What can be done? You should contact your doctor to prescribe drug relief of these symptoms. In many cases, the twitching will go away on its own over time.

Muscle weakness and joint stiffness

What’s happening? As the number of signals from motor neurons to muscles decreases, further they lose mass over time. This leads to a feeling of weakness and can cause imbalance and gait, which increases the risk of falling down.

What can be done? The decrease in muscle mass cannot be stopped by exercise, because the disease progresses irreversibly. However, exercise can help keep flexibility and mobility in your joints, which helps maintain muscle function, balance, and body position. You need to see your doctor to get a referral to a physical therapist who can put together a suitable exercise program. A dietitian can also help with advice on how to eat properly to keep body weight and further slow down the rate of muscle loss.

Muscle cramps and spasms

What’s happening? Muscle tension or spasms develops due to the deterioration of signal transmission from motor neurons. This leads to impaired motor activity and coordination of movements, as well as an increased risk of falls. Sudden muscle spasms can be extremely painful.

What can be done? To eliminate this symptom, as a rule, it is enough to change the position of the body while resting in a bed or chair. Part of the problem is exercise. In addition, your doctor may prescribe medications to relax your muscles.


What’s happening? Decreased physical functionality of muscles requires high energy expenditures to keep daily activity. Other causes of fatigue include trouble breathing, shortness of breath, decreased food intake, and dehydration.

What can be done? Make a plan for doing things for the day. This will help keep a balance between being active and getting adequate rest. A physical therapist can provide more detailed methods for solving the problem of fatigue. It is also important to consult your dietitian about increasing food calories and fluid intake.


What’s happening? ALS does not directly cause pain or discomfort. But they can be the result of a number of other reasons. For example, pain occurs as a result of muscle spasms, general spasticity, muscle tension, skin pressure, or constipation. Therefore, it is important to find out the cause of the symptom.

What can be done? There are recommendations for the adoption of optimal body positions, support, prevention of local compression and drug therapy. In case of prolonged pain, you must contact a medical institution. Your doctor can find the right pain reliever.

Swallowing problems

What’s happening? If the muscles of the face, mouth and larynx are affected, it becomes difficult to swallow. Disruption of the normal process of eating and swallowing is called dysphagia. As a result, a person receives less nutrients and fluids, which can lead to a decrease in body weight.

What can be done? It is necessary to contact a speech therapist and a nutritionist who will assess the degree of swallowing impairment and change in body weight, and also talk about possible solutions to the problem. You need to adjust the diet in order to increase the intake of proteins and carbohydrates with food. There are also alternative methods that can support or completely replace the diet.

Saliva and phlegm

What’s happening? When swallowing is impaired, an excess amount of saliva accumulates in the oral cavity, which leads to salivation and the associated discomfort. The consistency of the secretion can be either watery or thick. Increased viscosity is associated with a decrease in the amount of fluid entering the body. In this case, saliva is removed with great difficulty. Dry mouth can also develop due to medication, dehydration, breathing through the mouth, or mucosal candidiasis.

What can be done? Among the options for solving this problem are nutritional adjustments, drug therapy and the use of aspiration devices for cleaning the oral cavity (suction).

Cough and choking feeling

What’s happening? These phenomena can result from food or saliva getting into the airways.

What can be done? At the moment, there are effective techniques that help to deal with these problems. The attending physician will tell you about this.

Breathing problems

What’s happening? In ALS, the respiratory muscles are affected sooner or later. As the disease progresses – especially in the later stages – breathing problems develop. When this happens, the patient will need breathing devices and specialist advice.

What can be done? If a person experiences shortness of breath, weakness, sleep disturbances, morning headaches, or drowsiness during the day, their doctor may refer them to a pulmonologist. Methods for correcting the problem may include breathing and exercise, advice on creating a comfortable posture, effective coughing techniques, drug therapy, and special ventilation equipment.

Problems with speech and communication

What’s happening? As the muscles of the face and larynx weaken, the ventilation of the lungs further decreases, it becomes more difficult for a person to speak. This difficulty in speaking is called dysarthria.

What can be done? The attending physician will help to assess the problem and choose the techniques for its solution. We also recommend consulting a physiotherapist, who will recommend equipment or aids, depending on what kind of manipulation the person with ALS is capable of. Means for speech and communication (they are also called “means of alternative and auxiliary communication”) include both simple techniques (gestures, writing, alphabet tables, etc.) and more technically complex (using a computer).

Emotional lability (pseudo-bulbar effect)

What’s happening? Some people with ALS have bouts of uncontrollable laughing and/or crying that are difficult to control. These reactions are not common for all patients, and they are involuntary.

What can be done? Drug therapy can be used to relieve symptoms. Such reactions may cause some concern in others, but if they know that these manifestations are part of ALS symptoms, it will be easier for them to cope with it.

Emotional reactions

What’s happening? Some people with ALS experience a range of emotional states, including anxiety, fear, anger, sadness, depression, and denial. These reactions are normal.

What can be done? Being aware of your emotional states is the first step towards solving problems associated with stress. If these conditions are too expressed and persist for a long time, we strongly recommend that you seek help from a doctor. In some cases, drug therapy and/or psychotherapy is effective.

Violation of higher mental functions

What to do? Problems with memory, learning, word selection, or decreased concentration are known as higher mental functions. According to some reports, these conditions occur in 35% of patients with ALS, but they proceed rather unnoticed. Only in a few people they are extremely pronounced. In this case, one speaks of frontotemporal dementia, which is accompanied by severe impairment of cognitive functions.

What can be done? The participation of a multidisciplinary team of specialists, including psychologists and psychiatrists, is required.