Twitching becomes more meaningful when it occurs alongside **progressive muscle weakness or wasting**. ([Mayo Clinic][1])
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Lou Gehrig’s syndrome: Here are the first symptoms of this disease
Recurrent cramps may occur in ALS, particularly when they appear together with weakness or twitching.
Common locations include:
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* Calves
* Arms
* Shoulders
* Hands
Cramps alone are not a reliable indicator of ALS. Dehydration, exercise, medications, electrolyte disturbances, and nerve problems are much more common explanations.
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## 6. Slurred or Unclear Speech
Some forms of ALS first affect the muscles involved in speech.
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A person may notice:
* Slurred words
* A softer voice
* Hoarseness
* Difficulty pronouncing certain sounds
* Speech becoming slower or less clear
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Mayo Clinic identifies slurred speech as a possible early symptom, especially when ALS begins in muscles controlling the mouth and throat. ([Mayo Clinic][1])
Sudden speech difficulty, however, can also indicate a stroke and should be treated as an emergency.
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## 7. Difficulty Swallowing
ALS can weaken muscles involved in swallowing.
Early signs might include:
* Coughing during meals
* Choking more easily
* Difficulty swallowing certain textures
* Food feeling harder to move through the throat
* Taking much longer to finish meals
Trouble swallowing can have many causes and should be medically assessed, especially when it is new or worsening. ([Mayo Clinic][1])
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## 8. Progressive Muscle Wasting
When motor neurons no longer stimulate muscles normally, the affected muscles may gradually shrink.
This is called **muscle atrophy**.
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You might notice:
* One hand looking thinner than the other
* Reduced muscle bulk in an arm or leg
* Increasing weakness in the same area
* Clothes fitting differently because a limb has become thinner
Muscle wasting alongside weakness and twitching is one of the neurological patterns clinicians evaluate when considering ALS. ([Mayo Clinic][2])
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## 9. Muscle Stiffness
ALS can also cause increased muscle tone or stiffness.
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A person may feel that:
* Legs are unusually tight
* Movements are harder to initiate
* Walking feels stiff or awkward
* Muscles jerk unexpectedly
Neurologists refer to this type of increased muscle stiffness as spasticity.
## 10. Changes in Emotional Expression
Some people with ALS develop episodes of laughing or crying that seem exaggerated or inappropriate for the situation.
