ALS (Lou Gehrig’s Disease): Early Signs and Symptoms

Amyotrophic lateral sclerosis, abbreviated as ALS or popularly known as Lou Gehrig’s disease, is a nervous system disorder. It is a degenerative illness that affects the motor neurons, which ultimately affects muscle coordination and body movement.

There’s no approved cure for Lou Gehrig’s disease but there are many treatments that are used to slow down the progression of the condition and make life easier for patients. As a result, it is very important to be aware of the early signs of ALS so it can be managed promptly.

This article will talk about the early clinical features seen in this disease, as well as the treatment options available for patients.

Early Signs and Symptoms of ALS

ALS (Lou Gehrig’s Disease): Early Signs and Symptoms

Being aware of the early signs of ALS can make a big difference in the efficacy of the treatment options that are available for patients.

There are several features that you can keep an eye out for. So, what are early signs of ALS? Let’s discuss them in more detail below.

Muscle Weakness and Atrophy

In amyotrophic lateral sclerosis, there is degeneration of the motor neurons. This leads to weakness and even shrinking (atrophy) of a person’s muscles.

This can make lifting and moving limbs difficult, which can affect independent functionality.

Difficulty Speaking and Swallowing

Speaking and swallowing are two actions that are dependent on muscles, despite how little they might seem to be. These are among the early symptoms of ALS seen in patients with the bulbar-onset variant of the disease.

Difficulty speaking manifests with a change in tone, slurred, or hushed speech. With trouble swallowing, there can also be impaired tongue movement, making it harder to eat overall. Women are more likely to have the bulbar-onset type, so these are more likely to be the early signs of ALS in females. 

Cramps and Twitching

As the neurons responsible for controlling your muscles begin to break down, it can cause muscle cramping, which can be annoying and painful.

Patients might also notice muscle twitching, called fasciculations, which can actually be seen under the skin. This twitching can frequently affect sleep when it occurs.

Changes in Coordination and Balance

Muscle weakness in the limbs can also affect a person’s coordination and balance, and these are usually seen as some of the early signs of ALS. 

For instance, arm weakness can make it difficult to take care of tasks that require precision, like writing, eating with cutlery, buttoning clothing, and so on.

In the legs, ALS early symptoms include occasional stumbling or dragging of the feet. This can eventually result in tripping, and sometimes there can be “dropped foot”, which is seen when the muscles around the ankle can no longer hold the foot in the natural position during strides.

Unintentional Weight Loss

One of the early stage ALS symptoms that is rather interesting is unintentional weight loss. This occurs through multiple routes.

First of all, atrophy results in reduced muscle mass, which causes weight loss. Then, nearly half of the patients with Lou Gehrig’s disease experience severe loss of appetite.

Finally, early signs of ALS like difficulty swallowing can make eating normal quantities of food even harder.

Other Less Common Symptoms

There are other early warning signs of ALS that are a bit less common, but still as important to be aware of:

When to Seek Medical Attention

When you are able to see and identify very early ALS symptoms as they develop, it is important to seek medical attention as soon as possible.

This can make a big difference when it comes to the outcome that you’ll see as a patient.

Importance of Timely Diagnosis

There’s no definitive test to detect whether a person has Lou Gehrig’s disease. Your doctor will need to do a thorough physical examination to check for symptoms and signs of the condition. However, the sooner the diagnosis can be made, the better.

The reason for this is primarily because there’s no cure for this, and the quicker you are able to establish a diagnosis by identifying ALS early symptoms, the quicker you will be able to start an appropriate treatment option. Early treatment provides a more favorable outcome.

Red Flags to Watch Out For

Certain symptoms of amyotrophic lateral sclerosis should be considered “red flags” as they can indicate a very bad outcome.

These symptoms include the following:

  • Difficulty breathing
  • Changes in behavior
  • Cognitive impairment
  • Severe difficulty chewing or swallowing 
  • Muscle wasting

What to Expect During a Diagnostic Workup

If you spot Lou Gehrig disease early symptoms and go to the hospital, you might want to know exactly how your doctor might proceed.

Physical examination and your medical history are the basis for diagnosis, though some investigations can help rule out differentials.

  1. Your medical history is important in determining the nature and onset of symptoms. It can also help illuminate risk factors.
  2. The neurologic part of the physical exam is essential. It will be used to check for muscle weakness, atrophy, stiffness, reflexes, and so on.
  3. Investigations such as MRI, electromyography, and muscle biopsy can be used to rule out any other potential diagnoses.

Treatment Options

Most treatment options aim to control the symptoms and make life easier for the patient. However, research is constantly ongoing on finding options that can potentially repair damaged motor neurons.

Current Treatment Options for ALS

When you can detect very early ALS symptoms, many of the current treatment options available will be very useful in managing the condition.

These include the following:

  1. Medication: While most medication is used to treat symptoms, riluzole and edaravone have been shown to slow down the progression of the condition.
  2. Physical therapy: Since muscular impairment is the basis of this disease, physical therapy can help strengthen muscles and sustain mobility.
  3. Speech therapy: A speech therapist can help with techniques to maintain effective communication. In severe instances, electronic speech devices may be required.
  4. Respiratory support: The muscles for breathing can be affected by this disease and when they are weakened sufficiently, external breathing support will be ended. This can be through non-invasive ventilation or using mechanical ventilation.

The Role of Stem Cells in Treatment

While not an approved treatment for Lou Gehrig’s disease, stem cell therapy is promising because it has the potential to repair damaged motor neurons and regenerate new ones. This is something that other treatments are not capable of.

It hasn’t been shown that stem cells can cure ALS, but they have been proven to slow down the progression and improve symptoms.

At the same time, this therapy has been shown to be very safe, with most adverse effects being mild and reversible.

Multidisciplinary Approach to Care

Effectively treating amyotrophic lateral sclerosis involves a multidisciplinary approach and this is why there are many multidisciplinary clinics dedicated to treating this condition.

A study was able to show that this kind of care doesn’t only improve quality of life, but it also prolongs survival.

Supportive Measures to Improve Quality of Life

There are some basic supportive measures that one can take to improve their quality of life after Lou Gehrig disease early symptoms start to show up. 

For instance, dietary changes can be made to improve caloric intake despite the loss of appetite. Meals can also be modified to make them easier to swallow.

Mobility devices can be used to prolong independence after symptoms appear. This can include walkers, canes, and grab bars around the house.

Non-invasive ventilation can also be beneficial when the early symptoms ALS presents with begin to appear.

Importance of Early Detection and Treatment

This article has focused on the importance of being able to detect the early features of Lou Gehrig’s disease. This is because early suspicion can lead to a quick diagnosis, and with that, a better outcome.

Diagnosing amyotrophic lateral sclerosis can take a while for some patients, as many clinicians may not suspect it at first glance. It may take a series of investigations and examinations before the correct diagnosis is reached, even when the early signs of ALS in males and females are evident.

When this condition is diagnosed sooner, it typically results in prolonged survival and a higher quality of life. This is because management can start right away, allowing the progression of the disease to be slowed from the very start.

Hope for the Future of ALS Research and Treatment

Research is constantly in motion to learn more about ALS and find more effective ways to manage and treat it.

New medications are going through trial and approval processes to improve survival for patients. At the same time, stem cell therapy for treating amyotrophic lateral sclerosis is under intense study, and with the promise it presents, it won’t be a surprise to see a major breakthrough in a matter of years.

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Contact us to learn about the expected results of the treatment based on stem cells, as well as its cost and duration.

ALS (Lou Gehrig’s Disease): Early Signs and Symptoms
Dr. Aleksandra Fetyukhina, MD

Medical Advisor, Swiss Medica doctor

List of References

  1. Tefera, T. W., & Borges, K. (2017). Metabolic Dysfunctions in Amyotrophic Lateral Sclerosis Pathogenesis and Potential Metabolic Treatments. Frontiers in Neuroscience, 10.

  2. Hillel, A. D., & Miller, R. (1989). Bulbar amyotrophic lateral sclerosis: patterns of progression and clinical management. Head & neck, 11(1), 51–59.

  3. Muscular Dystrophy Association (n.d.). Amyotrophic Lateral Sclerosis (ALS): Signs and Symptoms. MDA.

  4. Holm, T., Maier, A., Wicks, P., Lang, D., Linke, P., Münch, C., Steinfurth, L., Meyer, R., & Meyer, T. (2013). Severe loss of appetite in amyotrophic lateral sclerosis patients: online self-assessment study. Interactive journal of medical research, 2(1), e8.

  5. Gautier, G., Verschueren, A., Monnier, A., Attarian, S., Salort-Campana, E., & Pouget, J. (2010). ALS with respiratory onset: clinical features and effects of non-invasive ventilation on the prognosis. Amyotrophic lateral sclerosis : official publication of the World Federation of Neurology Research Group on Motor Neuron Diseases, 11(4), 379–382.

  6. National Institute of Neurological Disorders and Stroke (n.d.). Amyotrophic Lateral Sclerosis (ALS). NINDS.

  7. Oh, K. W., Noh, M. Y., Kwon, M. S., Kim, H. Y., Oh, S. I., Park, J., Kim, H. J., Ki, C. S., & Kim, S. H. (2018). Repeated Intrathecal Mesenchymal Stem Cells for Amyotrophic Lateral Sclerosis. Annals of neurology, 84(3), 361–373.

  8. Mazzini, L., Fagioli, F., Boccaletti, R., Mareschi, K., Oliveri, G., Olivieri, C., Pastore, I., Marasso, R., & Madon, E. (2003). Stem cell therapy in amyotrophic lateral sclerosis: a methodological approach in humans. Amyotrophic lateral sclerosis and other motor neuron disorders : official publication of the World Federation of Neurology, Research Group on Motor Neuron Diseases, 4(3), 158–161.

  9. Hogden, A., Foley, G., Henderson, R. D., James, N., & Aoun, S. M. (2017). Amyotrophic lateral sclerosis: improving care with a multidisciplinary approach. Journal of multidisciplinary healthcare, 10, 205–215.

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Medical Advisor, Swiss Medica doctor

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