Amyotrophic Lateral Sclerosis (ALS) Symptoms

This condition is often abbreviated as ALS, but is also known as Lou Gehrig's disease, named after the famous baseball player who died of the disease. ALS is a motor neuron disease that destroys the nerve cells responsible for carrying signals from the brain to the muscles. When these cells die, one loses the ability to control the muscles that enable us to move, speak, breathe, and swallow, and the muscles gradually weaken and waste. The majority of the symptoms of ALS are directly related to muscle weakness. This weakness can begin in any part of the body and progresses very slowly. There are often muscle twitches, called fasciculations, and muscle cramps. Numbness, tingling, and pain are not common. The disease does not usually affect the nerves in the brain, so that one’s thinking is generally not affected.

The diagnosis of ALS is one of exclusion because at the onset ALS may mimic other disorders like strokes, carpal tunnel syndrome, or other neurological conditions. There is no specific, definitive test to diagnose ALS. Thus a physician will typically perform many different tests to rule out other diseases, including magnetic resonance imaging (MRI) of the brain and spinal cord, electrodiagnostic studies, including needle electromyography (EMG) and nerve conduction studies (NCS), along with a variety of blood and urine tests. A diagnosis of ALS is reached after evaluating the results of all the tests, along with the patient's medical history, and physician's physical examination.

The EMG is the most important test in this work-up because it gives the physician accurate information about what is happening within muscles and may be performed several times over a period of months to monitor for changes. The needle EMG results can also be used to rule out others diagnoses. Once the diagnosis of ALS is made, it is appropriate to get a confirmatory second opinion given the gravity of this disease.