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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.
Symptoms include pharyngeal muscle weakness (involved with swallowing), weak jaw and facial muscles, progressive loss of speech, and tongue muscle atrophy. Limb weakness with both lower and upper motor neuron signs is almost always evident but less prominent.oth upper and lower motor neurons are affected. Symptoms are usually noticed first in the arms and hands, legs, or swallowing muscles. Approximately 75 percent of people with classic ALS will develop weakness and wasting of the bulbar muscles (muscles that control speech, swallowing, and chewing).