What comes first in ALS muscle weakness or twitching?

What are the symptoms? The onset of ALS may be so subtle that the symptoms are overlooked. The earliest symptoms may include fasciculations (muscle twitches), cramps, tight and stiff muscles (spasticity), muscle weakness affecting a hand, arm, leg, or foot, slurred and nasal speech, or difficulty chewing or swallowing.

Does muscle weakness come first in ALS?

Not all people with ALS experience the same symptoms or the same sequences or patterns of progression. However, progressive muscle weakness and paralysis are universally experienced. A gradual onset of progressive muscle weakness – which is generally painless – is the most common initial symptom in ALS.

Where do ALS muscle twitches start?

To diagnosis ALS, a physician needs to see signs of progressive muscle weakness. What causes fasciculations? They originate at the very tips of the nerves, called axons, as they come close to being in contact with the muscle.

What was your first symptom ALS?

Early symptoms of ALS usually include muscle weakness or stiffness. Gradually all voluntary muscles are affected, and individuals lose their strength and the ability to speak, eat, move, and even breathe. Most people with ALS die from respiratory failure, usually within 3 to 5 years from when the symptoms first appear.

Does weakness come before atrophy in ALS?

ALS is characterized by a progressive degeneration of motor nerve cells in the brain (upper motor neurons) and spinal cord (lower motor neurons). When the motor neurons can no longer send impulses to the muscles, the muscles begin to waste away (atrophy), causing increased muscle weakness.

ALS: Mayo Clinic Radio

How does ALS weakness start?

ALS often starts in the hands, feet or limbs, and then spreads to other parts of your body. As the disease advances and nerve cells are destroyed, your muscles get weaker. This eventually affects chewing, swallowing, speaking and breathing.

Does ALS start distally or proximally?

The clinical presentation of ALS typically consists of adult onset focal muscle weakness and wasting, which has a tendency to spread with disease progression. The weakness most commonly starts in the limb muscles, more often in distal muscles than in proximal muscles.

What does early ALS weakness feel like?

ALS can start off with something as simple as a weak feeling in your hands or feet. It's a disease that attacks the brain cells that control a lot of your muscle movement. Eventually, ALS (amyotrophic lateral sclerosis or Lou Gehrig's disease) weakens the diaphragm, a muscle needed for your lungs to work.

Is twitching in ALS constant?

Fasciculations are a common symptom of ALS. These persistent muscle twitches are generally not painful but can interfere with sleep. They are the result of the ongoing disruption of signals from the nerves to the muscles that occurs in ALS.

Does ALS muscle weakness come and go?

With ALS, you may first have weakness in a limb that occurs over a few days or, more often, a few weeks. Then a few weeks or months later, weakness develops in another limb. For other people, the first sign of a problem may be slurred speech or trouble swallowing. As ALS progresses, more and more symptoms are noticed.

Does twitching with ALS come and go?

The sensation can be a one-off event or can continue sporadically for weeks or even months and in most cases will cease on its own. People living with ALS will often experience muscle twitching as the signal from the nerves to the muscles become more disrupted.

How do you rule out ALS?

Electromyography: EMG is one of the most important tests used to diagnose ALS. Small electric shocks are sent through your nerves. Your doctor measures how fast they conduct electricity and whether they're damaged. A second part of the test also checks the electrical activity of your muscles.

Is ALS muscle twitching widespread?

Answer: No, in ALS (even normal or other conditions), it is one kind of fasciculation. Clinically this refers to visible twitching of the muscle and are seen in the EMG needle examination as fasciculation potentials.

How fast do ALS symptoms progress?

Typically, the disease will progress over 2 to 5 years after diagnosis. However, 20% of patients live for more than 5 years, and about 5% live for 20 years or more. The name describes the condition. Amyotrophic comes from the Greek.

Does ALS cause numbness and tingling?

ALS doesn't cause numbness, tingling, or loss of feeling.

What does ALS spasticity feel like?

What are the symptoms? The onset of ALS may be so subtle that the symptoms are overlooked. The earliest symptoms may include fasciculations (muscle twitches), cramps, tight and stiff muscles (spasticity), muscle weakness affecting a hand, arm, leg, or foot, slurred and nasal speech, or difficulty chewing or swallowing.

What is the difference between fasciculations and twitches?

"Fasciculations occur when innervation from the peripheral nervous system to the muscle is not working correctly and a muscle is triggered involuntarily, causing it to twitch," says Dr. Ondo. "This is very common and these fasciculations usually go unnoticed, but in some cases, people do feel the muscle twitch."

Does ALS cause shaky hands?

Some ALS patients use the term "tremor" when they are actually having muscle failure. When people push their muscles to the limit, they can see their muscles react. It can look like a tremor because the muscle cannot generate any more force.

Does ALS affect all limbs at once?

Disease onset often occurs in one of two distinct ways: Limb Onset ALS or Bulbar Onset ALS. While disease onset is usually focal (symptoms start in one specific site – either limb or bulbar), multifocal (symptoms start in multiple sites) onset is possible and can occur in both limbs and bulbar regions simultaneously.

Does ALS start symmetrically?

Although ALS affects both sides of the body, atrophy may start on one side, becoming symmetrical as the disease progresses.

Does ALS start distal?

Approximately two thirds of patients with typical ALS have a spinal form of the disease (limb onset) and present with symptoms related to focal muscle weakness and wasting, where the symptoms may start either distally or proximally in the upper and lower limbs.

Does ALS muscle atrophy hurt?

Unfortunately, there are several reasons that the weakness associated with ALS can cause pain: Weak muscles can cause extra strain on muscles and joints, which often causes pain. This is most common in the neck, shoulders, and back.

Does ALS weakness get better with rest?

In fact these muscles are more susceptible to fatigue induced by exercise. While this will recover after a period of rest over minutes or hours it can result in a temporary increase in fatigue that may make arm or leg weakness transiently worse and result in temporary loss of function.

When should I be worried about muscle twitching?

Muscle twitches have a variety of causes, many of which are minor. You should see your doctor if the twitches are continuous, cause weakness or muscle loss, affects multiple body parts, begin after a new medication or new medical condition.

What are reflexes like in ALS?

When the upper motor neuron in lost, we see exaggerated and abnormal reflexes, like the knee-jerk reflex. When the lower motor neuron is sick, we see muscle wasting and weakness, associated with twitching (fasciculation) and cramping.