10 Early Signs of ALS Even Doctors Often Miss

Up to half of ALS cases go undiagnosed for over a year—proof of how easily its earliest signs slip past even trained eyes.

Amyotrophic lateral sclerosis (ALS) is a progressive neurological disorder affecting the motor neurons—the nerve cells in the brain and spinal cord responsible for controlling voluntary muscle movements. As these motor neurons degenerate and die, they stop transmitting signals to the muscles, resulting in muscle weakness, twitching, and eventual muscle wasting (atrophy).

ALS leads to a continuous decline in muscle function, affecting speech, swallowing, walking, and breathing. While some symptoms are obvious when the disease is more advanced, many early signs of ALS are subtle and often overlooked or mistaken for other conditions, which delays diagnosis and management. Early awareness of these signs is critical for timely medical evaluation.​

Muscle Twitching (Fasciculations)

Frequent or persistent involuntary muscle twitches, especially in the arms, legs, shoulders, or tongue, can signal early ALS. Unlike benign twitches, fasciculations in ALS are widespread and may accompany muscle weakness. They occur because dying motor neurons cause muscle fibers to contract erratically.​

Muscle Weakness and Clumsiness

Weakness commonly starts in one limb, making everyday tasks like buttoning a shirt, turning a key, or walking more difficult. This asymmetrical weakness reflects initial motor neuron dysfunction and may cause frequent tripping, dropping objects, or instability.​

Muscle Cramps and Stiffness (Spasticity)

Muscles may spasm painfully or feel abnormally stiff and tight, impairing normal movement. This spasticity occurs due to the involvement of upper motor neurons, which normally regulate muscle tone and reflexes.​

Difficulty with Fine Motor Skills

Subtle loss of dexterity can appear early, such as trouble writing neatly, buttoning clothes, or handling small objects. This reflects impairments in motor neurons affecting hand and finger muscles.​

Slurred or Nasal Speech

Weakness in the bulbar muscles controlling speech may cause speech to become slurred, slower, or nasal. These speech difficulties often progress gradually and can be mistaken for fatigue or other speech disorders.​

Difficulty Chewing and Swallowing (Dysphagia)

As the muscles involved in chewing and swallowing weaken, there may be choking, coughing while eating, or unexplained weight loss. Dysphagia is a serious early bulbar symptom that signals motor neuron damage affecting mouth and throat muscles.​

Changes in Walking Gait or Balance

People may develop a “foot drop,” dragging one foot while walking, or they may feel unsteady or frequently stumble. These changes result from leg muscle weakness and loss of coordination due to motor neuron degeneration.​

Muscle Atrophy

Visible shrinking or wasting of muscles in affected limbs, such as thinning in the arms or legs, may be apparent early as motor neurons fail to stimulate muscle maintenance.​

Fatigue without Cause

Unexplained fatigue or a feeling of muscle exhaustion with minimal activity can signal early ALS. Muscle fatigue happens as weakened muscles require more effort to perform daily functions.​

Speech and Emotional Changes

In some cases, emotional lability occurs early, with inappropriate laughing or crying due to involvement of certain brain pathways. Language or decision-making difficulties may also appear but are less common.​

Takeaway

Early signs of ALS often mimic common or less serious issues such as muscle cramps, clumsiness, or fatigue, leading to symptoms being missed or misattributed. Awareness of the subtle onset of muscle twitching, weakness, speech, and swallowing difficulties can prompt earlier diagnosis and intervention. If any of these signs persist or worsen, especially asymmetrically or progressively, seeking evaluation by a neurologist is essential to rule out ALS or other neurological disorders and to initiate appropriate care strategies.​

This vigilance can provide patients and families with valuable time for planning and accessing supportive treatments that can improve quality of life despite the challenging nature of ALS.

10 Symptoms of Lyme Disease That Americans Ignore All the Time

Lyme disease is a bacterial infection transmitted through the bite of infected blacklegged ticks. It’s prevalent in areas such as the Northeast, mid-Atlantic, and upper Midwest regions of the United States. Early detection is key, as untreated Lyme disease can result in severe complications affecting the joints, heart, and nervous system. Despite its seriousness, many Americans overlook the early warning signs of Lyme disease. 

This article highlights 10 symptoms that people frequently ignore, supported by direct links to credible sources for further information.

READ: 10 Symptoms of Lyme Disease That Americans Ignore All the Time