According to Anthony Geraci, MD, Director of Neuromuscular Medicine at Northwell Health, "ALS is generally diagnosed by neuromuscular neurologists." "Early indications include modest weakening of a limb, such as a minor foot drop that causes you to fall on occasion, or reduced finger dexterity, such as when typing on a computer." Larger muscle groups can also be affected, and the patient may have difficulty getting out of a chair or raising their arms to brush their hair. When ingesting liquids, some individuals have slurred speech or coughing as a first symptom. Muscle jerks and cramping are also early indicators."
Early ALS does not affect everyone in the same manner. Some patients may have symptoms in their arm or leg initially, which is known as limb onset. Others may experience early sensations in the muscles of the face and neck, as well as difficulties speaking or swallowing. Bulbar onset refers to when it first occurs in the face muscles. Which nerves and muscles are damaged initially determines the early symptoms. As the illness develops, more muscle groups get implicated, eventually affecting all of the body's muscles.
Pseudobulbar affect, or uncontrolled crying or laughing, is a symptom of ALS in some people. This symptom might last for the rest of your life as the condition progresses. Although anybody can get ALS, there are several risk factors to consider:
- People between the ages of 40 and 70 are most commonly affected by the illness.
- Men are somewhat more likely than women to acquire ALS, although this gap diminishes as they get older.
- Ethnicity: Caucasians and non-Hispanics are more prone to get the disease than those of other ethnicities.
- Veterans are twice as likely as non-veterans to get ALS. The reasons for this are unknown, although it might be due to lead poisoning, pesticide exposure, or other environmental pollutants. The US Department of Veterans Affairs recognizes it as a service-connected illness.
ALS can't be diagnosed with a single laboratory test. It is frequently diagnosed based on a comprehensive history of symptoms, physician observation, and exclusion (ruling out other conditions). If ALS is suspected, your doctor will ask you the following questions, according to Dr. Geraci:
- Do you trip over your feet when you walk?
- Do you find it difficult to get out of a chair?
- Do you find it difficult to hold a pen and write?
- Have you noticed a difference in your handwriting?
- Have you observed slurred speech in yourself or others?
- Have you had any muscular twitching or cramping recently?
Your doctor may recommend testing to rule out HIV, human T-cell leukemia, West Nile virus, multiple sclerosis, post-polio syndrome, and Kennedy's disease before establishing a diagnosis.
The following are some of the tests carried out throughout the diagnostic process:
- Electromyography (EMG) is a technique for detecting muscle fiber electrical activity.
- NCS is a nerve conduction investigation that measures nerve and muscle electrical activity.
- To rule out a spinal cord tumor, a herniated disk in the neck, syringomyelia, or cervical spondylosis, an MRI is used.
- Other illnesses may be ruled out using blood and laboratory testing.
- Your doctor should continue to do neurological tests on a frequent basis as the condition advances to track the disease's course and assess how rapidly symptoms deteriorate.
The majority of persons who develop ALS die from respiratory failure within one to five years of the beginning of symptoms. Only around ten percent of people live for ten years or more.
