Most people have never heard of Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s Disease. It is a rare neurodegenerative disease that affects the nerve cells in the brain and spinal cord. Signs that you may have ALS can be difficult to spot, as they are often mistaken for other conditions. This blog post will discuss the signs you don’t have ALS, how to tell if you are at risk, and what to do if you think you may have it.
Signs and Symptoms of ALS
The onset of ALS can be so subtle that the symptoms are overlooked, but gradually these symptoms develop into more obvious weakness or atrophy.
Early symptoms include:
- Muscle twitches/spasms in the arm, leg, shoulder, or tongue
- Muscle cramps
- Tight and stiff muscles (spasticity)
- Muscle weakness affecting an arm, a leg, the neck, or the diaphragm
- Slurred and nasal speech
- Difficulty chewing or swallowing
The first sign of ALS usually appears in the hand or arm and can show difficulty with simple tasks such as buttoning a shirt, writing, or turning a key in a lock. In other cases, symptoms initially affect one leg. People experience awkwardness when walking or running, or they may trip or stumble more often. When symptoms begin in the arms or legs, it is referred to as “limb onset” ALS, and when individuals first notice speech or swallowing problems, it is termed “bulbar onset” ALS.
As the disease progresses, muscle weakness and atrophy spread to other body parts. Individuals may develop problems with moving, swallowing (called dysphagia), speaking or forming words (dysarthria), and breathing (dyspnea). However, the sequence of emerging symptoms and the rate of disease progression can vary from person to person. Eventually, individuals will not be able to stand or walk, get in or out of bed on their own, or use their hands and arms.
Individuals with ALS usually have difficulty swallowing and chewing food, which makes it hard to eat. They also burn calories at a faster rate than most people without ALS. Due to these factors, people with ALS tend to lose weight rapidly and can become malnourished.
Because people with ALS usually can perform higher mental processes such as reasoning, remembering, understanding, and problem-solving, they are aware of their progressive loss of function and may become anxious and depressed. A small percentage of individuals may experience problems with language or decision-making, and there is growing evidence that some may even develop a form of dementia over time.
Individuals with ALS eventually lose the ability to breathe on their own and must depend on a ventilator. Affected individuals also face an increased risk of pneumonia during the later stages of the disease. Besides muscle cramps that may cause discomfort, some individuals with ALS may develop painful neuropathy (nerve disease or damage).
ALS: What exactly happens to the body?
ALS is caused by the death of motor neurons in the brain and spinal cord. These neurons are responsible for sending signals from the brain to the muscles. When they die, the muscles weaken and waste away. Clinical weakness, which is being unable to do what everyone else can, is a sign of upper motor neuron disease. There is no known cure for ALS, and it is always fatal.
If you think you may have ALS, it is important to see a doctor as soon as possible. The earlier the disease is diagnosed, the better your chances are of managing its symptoms and prolonging your life.
Causes of ALS
The exact cause of ALS is unknown, and scientists do not yet know why ALS strikes some people and not others. Several risk factors have been identified. These include:
- Heredity. Five to 10 percent of people with ALS inherited the disease (familial ALS). For most people with this ALS type, their children have a 50-50 chance of developing the disease.
- Age. ALS risk increases with age and is most common between the ages of 40 and the mid-60s.
- Sex. Before the age of 65, slightly more men than women develop ALS. This sex difference disappears after age 70.
- Genetics. Some studies examining the entire human genome found many similarities in the genetic variations of people with familial ALS and those with noninherited ALS. These genetic variations might make people more susceptible to ALS.
Environmental factors, such as the following, might trigger ALS.
- Smoking. Smoking is the only likely environmental risk factor for ALS. The risk seems to be greatest for women, particularly after menopause.
- Environmental toxin exposure. Some evidence suggests that exposure to lead or other substances in the workplace or home might be linked to ALS. Much study has been done, but no single agent or chemical has been consistently associated with ALS.
- Military service. Studies indicate that people who have served in the military are at higher risk of ALS. It’s unclear what about military service might trigger the development of ALS. It might include exposure to certain metals or chemicals, traumatic injuries, viral infections, and intense exertion.
ALS and MS: Similar, but not the same
Multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) are different diseases with some similar features and symptoms.
- Affect your muscles and your ability to move your body
- Attack your brain and spinal cord
- Have “sclerosis” in their name
- Cause scarring or hardening around nerve cells
They have some key differences, though. MS is an autoimmune disease that causes your body to attack itself. Lou Gehrig’s disease, on the other hand, is a nervous system disorder that wears away nerve cells in your brain and spinal cord. Hence, although symptoms and signs may look and feel similar, Both are treated differently.
Myths about ALS
ALS is strictly hereditary.
In reality, most people diagnosed with ALS have no family history of the disease. About 90 percent of ALS cases are sporadic, meaning the cause or causes are unknown. The remaining 10 percent of ALS cases are familial and inherited through a mutated gene. In those families, there is a 50% chance that each offspring will inherit the gene mutation and may develop the disease.
There are several research studies – past and present – investigating possible risk factors that may be associated with ALS. More work is needed to conclusively determine what genetics and/or environmental factors contribute to developing ALS. It is known, however, that military veterans are approximately twice as likely to develop ALS.
Only older people are affected by ALS.
Most people who develop ALS are between the ages of 40 and 70, with an average onset of 55. But there are many cases of people in their twenties and thirties who have been diagnosed with ALS. This “young onset” ALS typically refers to people younger than 45 years old and accounts for about 10% of all cases.
Although the life expectancy of a person with ALS averages about two to five years from the time of diagnosis, the disease is variable. Many people can live with the disease for five years or longer. More than half of all people with ALS live more than three years after diagnosis.
ALS does not affect brain function.
While not common, approximately 20% of individuals with ALS also develop frontotemporal degeneration (FTD), which is characterized by changes in personality, behavior, and speech. Another rare form of ALS, known as ALS-parkinsonism-dementia complex (ALS-PDC), is characterized by signs and symptoms of ALS in addition to movement abnormalities (slow movements, stiffness and tremors) and loss of intellectual function. Cognitive and behavioral impairment in ALS can vary widely from individual to individual.
Some people with ALS develop a symptom called “pseudobulbar affect.” They may cry or laugh at inappropriate times or notice how once they start feeling an emotion, it is difficult to suppress it and not express it. Pseudobulbar affect is common in ALS and results from a brain reflex no longer working correctly. People with ALS can have pseudobulbar affect and no other cognitive, behavioral, or psychological symptoms.
Muscle loss and paralysis caused by ALS means you can’t feel pain or experience other sensations.
People with ALS, even at an advanced stage, can still see, hear, smell, and feel touch. The nerves that carry feelings of hot, cold, pain, pressure, or even being tickled, are not affected by ALS. ALS is a disease that affects the parts of the nervous system that control voluntary muscle movement. Involuntary muscles, those that control the heart, GI tract, bowel/bladder function, and sexual functions, are not directly affected by ALS.
ALS affects everyone in the same way.
From the initial symptoms to how the disease progresses, ALS can affect people very differently. In fact, no two individuals present exactly the same. Some people’s disease progresses very slowly, while others have changes that happen more quickly. Some individuals have severe involvement in one area before the disease spreads, while others experience rapid progression throughout their bodies. Some people may have severe weakness in one area, but little in others (e.g., unable to swallow but still able to walk and drive), and still others may demonstrate a similar severity of involvement in different areas.
Eventually, ALS removes the ability to walk, dress, write, speak, swallow, and breathe. How fast and in what order this occurs is very different from person to person.
ALS and How to know if you don’t have it
Many different neurodegenerative diseases can affect the brain and spinal cord’s motor neurons, but not all are alike. So how can you tell if you have ALS? Here are some signs that indicate you don’t have this particular disease:
– You’re still able to move all your muscles normally.
– You don’t have any difficulty speaking or swallowing.
– You haven’t lost any muscle mass.
– You don’t experience shortness of breath.
If you’re experiencing any of these symptoms, it’s important to see a doctor as soon as possible so they can rule out other conditions and begin testing for ALS.
Can you have ALS for years and not know it?
ALS is a progressive disease, which means that it gets worse over time. The early signs of ALS may be so mild that they go unnoticed. Sometimes, people with ALS may live for years without knowing they have the disease.
This is why it’s so important to see a doctor as soon as you notice any changes in your health. Early diagnosis and treatment can make a big difference in prolonging your life and managing your symptoms.
We hope this blog post has helped clarify the early signs of ALS. Please remember, if you think you may be at risk for ALS, it is important to see a doctor as soon as possible.