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.
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## 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
