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Symptoms of ALS

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The symptoms of ALS develop at different rates for different people. In the early stages
of ALS, signs and symptoms can be so slight that they may be overlooked, at least until
they develop into more obvious weaknesses or visible atrophy.
Common symptoms of ALS include:

Difficulty in carrying out daily activities, including walking

Increased clumsiness

Weakness in the feet, hands, legs and ankles

Cramping and twitching in the arms, shoulders or tongue

Difficulty in maintaining good posture and holding the head up

Uncontrolled outbursts of laughing or crying (emotional lability), and cognitive


changes

Slurring of speech and difficulty with voice projection

Pain

Fatigue

Saliva and mucus problems

Difficulties with breathing and swallowing (in advanced cases).

ALS can make the leg muscles weaken, meaning that simple actions such as walking can
become difficult.

Progressive muscle weakness occurs in all cases of ALS, although muscle


weakness may not be the first indication of the condition. Early symptoms often include
clumsiness, abnormal limb fatigue, muscle cramps and twitches (fasciculations) and
slurred speech. Symptoms will spread to all parts of the body as ALS progresses.
Some people with ALS can also experience symptoms of impaired decision-making and
memory, eventually leading to a form of dementia called frontotemporal dementia.
Emotional lability is also a symptom of ALS in some people - this is known as the
pseudo-bulbar effect and can cause people to have more extreme fluctuations in mood
and emotional response.

Diagnosis of ALS

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There is no single test used to diagnose ALS. Instead, a health care provider will make
a diagnosis based on the patient's symptoms and results of tests used to rule out other
conditions that can cause similar symptoms.

MRI scans can be used to locate problems such as herniated disks that cause symptoms
similar to ALS.

Two types of test that may be used to diagnose ALS are


called electromyography (EMG) and nerve conduction study (NCS). These tests can
detect electrical energy in muscles and the ability of nerves to send signals respectively.
EMG and NCS can be used to support ALS diagnosis and to rule out
peripheral neuropathy (peripheral nerve damage) and myopathy (muscle disease).

Magnetic resonance imaging (MRI) does not reveal evidence of ALS, but can be used
to show other problems that could be causing the patient's symptoms. These problems
include spinal cord tumors and herniated disks in the neck.
Doctors can also request that blood and urine tests are carried out, as well as tests on
spinal fluid samples extracted through a lumbar puncture. A muscle biopsy may also
be carried out in order to rule out myopathy.
As well as the conditions mentioned above, the following medical problems can also
produce similar symptoms to ALS, and thus may need to be ruled out during the
diagnostic process:

Human immunodeficiency virus (HIV)


Lyme disease

Multiple sclerosis
Polio

West Nile virus.

The presence of both upper and lower motor neuron symptoms is believed to be a
strong indicator of ALS. Upper motor neuron symptoms include stiffness and resistance
to movement in the muscles, and brisk reflexes. Lower motor neuron symptoms include
weakness, muscle atrophy and twitching.
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Recent developments on ALS diagnosis from MNT news


Clinician's 'primer' to genome and exome sequencing published
Experts warn that physicians do not know enough about genetics to understand the
strengths and weaknesses of such tools. But clinicians have already ordered several
thousand tests - particularly to help with cases of rare childhood diseases - suggesting
that, ready or not, the technology has already entered the realm of general medical
practice.

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