The onset of ALS/MND may be so subtle that symptoms are overlooked or misread. The earliest symptoms may include:
- Muscle weakness
- Muscle twitches (fasciculations)
- Cramps and/or tight and stiff muscles (spasticity)
- Muscle loss and/or atrophy
- Slurred and nasal speech
- Difficulty chewing and swallowing
- Excessive choking
- Excessive shortness of breath
- Unintended weight loss
- Hand or leg weakness
- Problems with balance or walking
These general complaints then develop into more obvious weakness, atrophy or rigidity that may cause a physician to suspect ALS/MND. The parts of the body showing early symptoms of ALS/MND depend on which muscles in the body are affected. Many individuals first see the effects of the disease in a hand or arm as they experience difficulty with simple tasks requiring manual dexterity such as buttoning a shirt, writing, or turning a key in a lock.
In other cases, symptoms initially affect one of the legs, and people experience awkwardness when walking or running or they notice that they are tripping or stumbling more often. When symptoms begin in the arms or legs, it is referred to as “limb onset” ALS/MND. Other individuals first notice changes in voice and speech, spasms in muscles of the jaw, face, voice box, throat and tongue, and inappropriate excessive laughing and crying, all of which suggest “bulbar onset” ALS/MND.
How is ALS/MND Diagnosed?
No single test can provide a definitive diagnosis of ALS/MND, although the presence of both upper and lower motor neuron signs is strongly suggestive. Instead, the diagnosis of ALS/MND is primarily based on the symptoms and signs the physician observes in the patient and a series of tests to rule out other diseases. Physicians obtain the individual’s full medical history and usually conduct a neurologic examination at regular intervals to assess whether symptoms such as muscle weakness, atrophy of muscles, overactive reflexes and tight and stiff muscles are getting progressively worse. Tests that may be performed, in addition to clinical observation, include electromyograms (EMG), forced vital capacity (FVC) and other respiration tests, lumbar puncture and complete blood laboratory analysis.