Recurrent cramps may occur in ALS, particularly when they appear together with weakness or twitching.

Common locations include:

* Calves
* Arms
* Shoulders
* Hands

Cramps alone are not a reliable indicator of ALS. Dehydration, exercise, medications, electrolyte disturbances, and nerve problems are much more common explanations.

## === PAGE BREAK – NEXT PAGE ===

## 6. Slurred or Unclear Speech

Some forms of ALS first affect the muscles involved in speech.

A person may notice:

* Slurred words
* A softer voice
* Hoarseness
* Difficulty pronouncing certain sounds
* Speech becoming slower or less clear

Mayo Clinic identifies slurred speech as a possible early symptom, especially when ALS begins in muscles controlling the mouth and throat. ([Mayo Clinic][1])

Sudden speech difficulty, however, can also indicate a stroke and should be treated as an emergency.

## 7. Difficulty Swallowing

ALS can weaken muscles involved in swallowing.

Early signs might include:

* Coughing during meals
* Choking more easily
* Difficulty swallowing certain textures
* Food feeling harder to move through the throat
* Taking much longer to finish meals

Trouble swallowing can have many causes and should be medically assessed, especially when it is new or worsening. ([Mayo Clinic][1])

## 8. Progressive Muscle Wasting