In order for a definitive diagnosis of ALS to .
be made, damage must be evident in both upper and lower motor neurons. When three limbs are sufficiently affected, the diagnosis is ALS. .
ALS is a progressive, degenerative, neuromuscular disease that weakens and eventually destroys motor neurons. These motor neurons are the components of the nervous system that connect the brain with the skeletal muscles. Skeletal muscles are involved with voluntary movements, such as walking and talking. The motor neurons transmit the command to move from the brain to the skeletal muscles, which respond by contracting. Once a motor neuron degenerates completely, the muscle that it controls no longer receives impulses from the brain. Approximately 60% of ALS patients experience muscle weakness and stiffness as the initial symptom. Usually the first muscles affected are those in the arms and legs. Walking or climbing stairs may be difficult. The patient may drop things, fall, experience muscle cramps, and laugh or cry uncontrollably. The arms and legs may feel especially tired. If the hands are affected, the patient may have difficulty picking up small objects or turning keys. Speech problems, such as slurring, hoarseness, or decreased volume may also occur. Signs and symptoms of ALS include: absence of spinal reflexes, loss of muscle tone, muscle twitching and muscle wasting. As symptoms progressively worsen, the patient's muscles wither causing spasticity, stiffness, abnormal movements, and alterations in step and manual dexterity. Twitching may occur in the tongue and in affected limbs. The patient may experience muscle pain and muscle cramps, as well as rapidly alternating muscle contractions and relaxations. Some patients experience more .
3.
difficulty swallowing saliva and liquids than solid food. Excessive salivation and difficulty swallowing may cause drooling. When respiratory muscles weaken, the patient may require a ventilator.