The initial onset of ALS, symptoms may be so slight that they are frequently overlooked. Most symptoms develop later in adulthood, usually after the age of 50. However, they can occur in younger people. People who experience ALS have a loss of muscle strength and coordination that gradually gets worse. Muscle weakness may occur in hands, arms or legs or the muscles of speech, swallowing and breathing. Often the early signs include twitching and muscle cramps, especially in the hands and feet. These signs can vary significantly from person to person. Symptoms often begin with tripping or falling spells. For others, symptoms begin with slurred speech or episodes of crying or laughing.
Muscle weakness is the hallmark sign in ALS, occurring in approximately 60 percent of patients. Hands and feet may be affected first. Difficulty lifting items, buttoning clothes or walking are common signs. As the disease begins to worsen, it spreads to the trunk muscles of the body. This leads to dysfunction or weakening of speech, swallowing, chewing and breathing. When breathing muscles become affected, the patient will require permanent ventilator support to survive. These signs represent the end stage of the disease process.