Symptoms of ALS
Muscle weakness is often a prominent problem for ALS patients. This affects their ability to perform everyday tasks, such as walking, speaking, and eating. It can also make chewing and swallowing difficult, and result in impaired breathing. Other muscle problems include twitches, cramps, spasms, pain, and stiffness (spasticity). Some patients may experience tremor-like symptoms, which is the result of muscle failure when muscles are pushed to their limit.
In some cases, breathing difficulties are among the first symptoms of ALS, as the chest muscles and diaphragm that control breathing become affected. In other patients, breathing difficulties may only appear as the disease progresses. Common breathing problems reported in ALS patients are increased breathlessness, shortness of breath, shallow breathing at night causing sleep interruptions, and breathing discomfort while speaking, sitting, or doing other activities.
ALS patients may experience cramping, constipation, and bladder urgency. These problems may be so mild that patients are unaware that the symptoms are connected to their ALS. The disease may also change the composition of the harmless microorganisms that inhabit the digestive system and assist with food digestion — the so-called gut microbiome. Changes in the gut microbiome have been linked to a number of health conditions.
Muscle weakness in ALS can include not only muscles that control movement of the limbs and other parts of the body, but also the muscles required for breathing, swallowing, and speaking. Swallowing requires the combined action of many different muscles of the lips, tongue, and throat. Muscles in the tongue help to move the food inside the mouth and to clear the mouth when swallowing. Any of these muscles can be affected in ALS, which impairs the swallowing process.
Speech problems, or dysarthria, are common and among the first symptoms of ALS. They occur during the early stages and usually worsen as the disease progresses. ALS causes a reduction in the stimulation of muscles that control the movement of the lips, jaw, tongue, and vocal cords. by motor neurons such that their proper use becomes difficult. Some muscles that are involved in the speaking process also become weak over time because they are not used.
Anxiety and Depression
Anxiety and depression are common in patients diagnosed with ALS, particularly immediately following a diagnosis. As the condition progresses, patients usually retain their mental reasoning, thinking, and sensory abilities, and are aware of their progressive loss of motor function. This can make them prone to anxiety and depression. However, episodes of depression in ALS are generally brief and respond well to treatment.
Pseudobulbar affect is a condition characterized by bouts of sudden, uncontrolled laughter or crying that occur in some people with ALS. These outbursts often seem out of proportion or incongruent with the situation, and do not necessarily match how the person is actually feeling. They can be quite severe and can occur as often as several times a day. The condition may affect a person’s employment or relationships. Embarrassment or anxiety about the episodes may cause patients to become isolated.