Which is typically the initial symptom of ALS?

Which is typically the initial symptom of ALS?

• A. Foot drop
• B. Fasciculations
• C. Dysphagia
• D. Weakness of hands

Answer: (D)

ALS typically starts with focal, asymmetric weakness in a limb, most often in the small hand muscles. This initial hand weakness shows up as trouble with fine motor tasks—gripping, buttoning, or manipulating objects—and may be accompanied by early muscle wasting. These features reflect early degeneration of motor neurons supplying distal hand muscles, which is a common first clue in ALS. Fasciculations can occur early, but they are not as consistently the first symptom as weakness is. Dysphagia and other bulbar problems usually appear later as the disease progresses, and foot drop could occur but is less commonly the very first sign than hand weakness.

ALS typically starts with focal, asymmetric weakness in a limb, most often in the small hand muscles. This initial hand weakness shows up as trouble with fine motor tasks—gripping, buttoning, or manipulating objects—and may be accompanied by early muscle wasting. These features reflect early degeneration of motor neurons supplying distal hand muscles, which is a common first clue in ALS.

Fasciculations can occur early, but they are not as consistently the first symptom as weakness is. Dysphagia and other bulbar problems usually appear later as the disease progresses, and foot drop could occur but is less commonly the very first sign than hand weakness.