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Amyotrophic Lateral Sclerosis
The onset of amyotrophic lateral sclerosis may be so gradual that the signs and symptoms are often overlooked. Early symptoms usually include twitching, cramping, or muscle stiffness; muscle weakness affecting a leg or an arm; slurred and nasal-sounding speech; or difficulty swallowing and problems chewing food. What follows is the development of more obvious weakness that may cause a doctor to consider the diagnosis of ALS.
The body parts affected by early symptoms of amyotrophic lateral sclerosis depend on which muscles are damaged first. Often, symptoms initially affect one of the legs, and patients experience awkwardness when running or walking. Sometimes they note that they are stumbling or tripping with greater frequency. Sometimes patients first notice the effects of ALS on an arm or hand as they experience problems completing minor tasks that require manual dexterity such as writing, buttoning a shirt, or turning a key in a car door.
Muscle weakness spreads to other parts of the body as ALS progresses. Patients may notice increased difficulty moving, swallowing, and speaking. Symptoms of upper motor neuron involvement include spasticity and hyperreflexia. Symptoms of lower motor neuron degeneration often include muscle weakness and atrophy, muscle cramps, and fasciculations.
To make the diagnosis of amyotrophic lateral sclerosis, a patient must have signs and symptoms of both upper motor neuron damage and lower motor neuron damage that cannot be attributed to other conditions.
The progression of ALS varies from person to person. Eventually ALS patients will be unable to walk or stand , get out of bed without assistance, or use their arms and hands. Weight maintenance often becomes a problem due to the patient having difficulty swallowing. ALS usually does not affect cognitive abilities. In most cases patients are aware of their progressive loss of function and often become depressed. As the disease progresses, ALS patients have trouble breathing as the muscles of the respiratory system become affected. In time, patients eventually lose the ability to breathe without assistance and require a ventilator for survival.
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