The onset of ALS is often very subtle - these are the initial ALS Symptoms to watch for:

• twitching and cramping of the muscles, especially those in the hands and feet
  
• muscle weakness in the arms or legs
• loss of motor control in the arms or legs
• general weakness and fatigue
• tripping and falling
• dropping things
• slurred or thick speech
• difficulty chewing or swallowing
• uncontrollable periods of laughing or crying

The parts of the body affected by early symptoms of ALS depend on which muscles in the body are damaged first. For instance, one person may experience trouble grasping or lifting, another person notices that he is stumbling or tripping more often, and a third person may notice episodes of slurred speech.

Muscle weakness is a hallmark initial sign in ALS, occurring in approximately 60% of patients. About 25% have bulbar (throat) onset, which means that voice and swallowing are first affected. About 50% have arm onset, and 25% leg onset.

Regardless of the part of the body where ALS first makes an appearance, muscle weakness and atrophy eventually spread as the disease progresses. Later symptoms may include:

• shortness of breath
• difficulty breathing
• difficulty swallowing
• difficulty chewing
• tight and stiff muscles
• complete paralysis
  

Although the rate at which the disease progresses varies from person to person, if the disease remains unchecked all ALS patients will eventually succumb to complete paralysis, including needing a ventilator to breathe and a feeding tube for nourishment.