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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.
Most people with ALS first feel muscle cramps, spasms or twitching (fasciculations) in one of their arms or legs. Other signs include weakness in the hands and feet or loss of balance. This form of the disease is called limb-onset ALS. About 25% of people with ALS first have trouble talking clearly - slurring words.