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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.
The onset of ALS may be so subtle that the symptoms are overlooked. The earliest symptoms may include fasciculations, cramps, tight and stiff muscles (spasticity), muscle weakness affecting an arm or a leg, slurred and nasal speech, or difficulty chewing or swallowing.hen symptoms begin in the arms or legs, it is referred to as âlimb onsetâ ALS. Other individuals first notice speech problems, termed âbulbar onsetâ ALS. Regardless of the part of the body first affected by the disease, muscle weakness and atrophy spread to other parts of the body as the disease progresses.