ALS can progress very differently. 25 percent of the patients complain of an increasing muscle weakness and muscle atrophy in the small hand muscles at first and then in the whole arm. In other cases, the incurable process starts in the legs. Cramps and a decrease of the face muscles are also signs of ALS. The consequence is a progressive deterioration of facial expression.
The speech also suffers because of the increasing paralysis. It seems slower and more slurred, and even swallowing becomes harder. In about 20% of ALS patients, the disease begins with these symptoms. The symptoms only affect the extremities later on. Other symptoms of ALS: