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Early signs and symptoms of ALS include: 1  Difficulty walking or doing your normal daily activities. 2  Tripping and falling. 3  Weakness in your leg, feet or ankles.  Hand weakness or 1  clumsiness. Slurred speech or trouble swallowing.  Muscle cramps and twitching in your arms, shoulders and 1  tongue. Difficulty holding your head up or keeping good posture.
Not all people with ALS experience the same symptoms or the same sequences or patterns of progression. However, progressive muscle weakness and paralysis are universally experienced. Gradual onset, painless, progressive muscle weakness is the most common initial symptom in ALS. Other early symptoms vary but can include tripping, dropping things, abnormal fatigue of the arms and/or legs, slurred speech, muscle cramps and twitches, and/or uncontrollable periods of laughing or crying.