Symptoms of Amyotrophic Lateral Sclerosis

Early detection of amyotrophic lateral sclerosis (ALS) is a complicated task. There are a few tests that can help, however. Learn about them in this article.
Symptoms of Amyotrophic Lateral Sclerosis

Last update: 02 October, 2021

Researchers are constantly trying to find better ways to diagnose amyotrophic lateral sclerosis, also known as Lou Gherig’s disease. You might’ve heard it called ALS.

This serious disease is progressive and, as of today, unstoppable. There are treatment protocols that delay some of the symptoms. However, it’s always deadly and in a relatively short time. In fact, the survival rate of less than 50% after the first three to five years of having the disease.

Amyotrophic lateral sclerosis

To detect amyotrophic lateral sclerosis or ALS, it’s necessary to refer to the nervous system. This is because it’s a degenerative neuronal condition that progresses fast. This means it evolves inevitably and leads to the deterioration of functions.

It tends to attack the cerebral motor and the spinal cord neurons. Each one of these affected cells loses its functional capacity, and this translates into a lack of muscle strength, loss of tone, and paralysis.

Loss of movement is only one of the problems people with this condition have. In fact, neurons command the respiratory system and the muscles of the thorax and so these patients usually require artificial respirators. Note that plugging into devices ensures neither the quality of life nor long-term survival.

The social and psychological component here isn’t minor. After an ALS diagnosis, the attending physician will explain the expected evolution of the disease to their patient. Indeed, it’s hard to deal with such news, not only for the patient but for their family and friends.

The origins and causes of this disorder aren’t clear. Almost all of those diagnosed lack factors that explain the appearance and aren’t at an age that would lead to cellular aging. The genetic part is still under debate as only less than 10% of the patients have a family history of this disease.

A doctor holding a picture of a brain.
Tge main characteristic of amyotrophic lateral sclerosis (ALS) is a progressive deterioration of neurons.

Also, read about: The Four Types of Multiple Sclerosis

Suspecting and detecting amyotrophic lateral sclerosis according to the symptoms

Signs and symptomatology are the first basis for initiating the detection of ALS. In particular, there’s a loss of strength and atrophy of the muscles people can no longer use. Thus, the shrinkage of myocytes (muscle cells) begins in the lower limbs and hands.

Affected muscles tend to cramp and there are frequent painful episodes. Along with this, there are fasciculations — involuntary movements of individual fibers, perceptible under the skin.

The degeneration continues and if a person doesn’t implement therapies or rehabilitation digestive and respiratory symptoms will occur within a short amount of time. People with ALS notice they can’t eat as before because it’s harder to swallow as the tongue moves abnormally.

However, there are cases with overlapping symptoms that take a while to fully manifest. Shortness of breath or dyspnea is one of these problems, which go unnoticed at first but become limiting once installed.

There’s no chronic pain though, except for some cramping. Also, there’s no loss of cognitive function. Part of the detection of amyotrophic lateral sclerosis establishes a differential diagnosis with other conditions that do alter memory and thinking.

Types of amyotrophic lateral sclerosis

According to the initial presentation of symptoms, medical societies established protocols and consensus that classify the disease to detect ALS more accurately. Thus, the current types are:

  • Up to one-third of patients suffer from Bulbar, the first signs manifest in the oral region.
  • Medullary as the first sign is the vast majority of patients takes place in the lower or upper limbs.
  • Respiratory signs are rare as dyspnea is a late sign, but the onset is shortness of breath in some patients, together with changes in swallowing and speech.
A person in a wheelchair.
Amyotrophic lateral sclerosis can lead to weakness or dysfunction of the lower or upper limbs.

Also, read about: Arteriosclerosis of the Extremities and Its Causes and Treatments

Detecting ALS with complementary methods

Symptoms alone aren’t sufficient to establish the diagnosis. Thus, doctors must conduct complementary methods that certify the alteration and meet the criteria for naming the disorder.

Detecting amyotrophic lateral sclerosis involves a tour of medical teams and specialists who add studies in various areas. Let’s see what are the most important tests.


This is usually one of the first prescriptions and the neurologist requests an electromyogram upon consultation of a person with unexplainable muscle weakness.

A technician places needle-shaped electrodes inside the affected muscle to measure nerve transmission. It’s a basic test that usually orients the diagnosis towards confirmation.

Blood test

This test won’t contribute to the detection of ALS; however, it’ll rule out other processes that are part of the differential diagnosis. A neurological infection, for example.

Lumbar puncture

Like a blood test, this kind of puncture can rule out similar processes such as meningitis and encephalitis. However, some patients shouldn’t undergo this test because it isn’t necessary when a doctor is pretty sure the patient has ALS.

In addition, it’s a rather invasive method and consists of a physician inserting a needle into the internal space where the cerebrospinal fluid lodges, inside the spinal column.

Nerve conduction

As an adjunct to the electromyogram, this conduction study measures the impulses the nerves send to the muscle areas.

A person with amyotrophic lateral sclerosis.
The nerve conduction test is for determining the speed at which impulses travel through a nerve.

Magnetic resonance imaging

This imaging test obtains photographs of the nervous system through a magnetic field. Its purpose is to rule out neurological tumors. Also, it’s an accessible method and thus the first one is usually requested.

Muscle biopsy

Doctors don’t always request a biopsy but it’s one more element in the process of detecting ALS. This is because it analyzes the integrity of the muscle tissue and the presence of a possible myocyte that might be simulating ALS.

Is early detection of amyotrophic lateral sclerosis possible?

Overall, it’s definitely possible to detect this disease early but the fact is that the cases in which it happens depend more on the neurologist’s expertise and the speed of the consultation than on other factors. Doctors don’t always suspect it and the whole process of complementary tests can’t happen in one run.

Finally, no one should ignore muscular and neurological symptoms. Anyone with extreme fatigue, repeated cramps, and twitching should consult a neurologist and conduct the basic tests. There must be further investigation until finding the underlying causes for any situation that warrants it.

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