"Where Does the Weakness Start in ALS (Amyotrophic Lateral Sclerosis)?"

Amyotrophic Lateral Sclerosis, also known as ALS, typically starts with weakness in the extremities. It is a chronic, progressive degenerative disease that affects both upper and lower motor neurons, as well as the muscles of the trunk, limbs, head, and face that these neurons control. ALS often manifests as progressively worsening muscle weakness, atrophy, and fasciculations due to the combined damage to both upper and lower motor neurons. The common initial symptoms include clumsy and weak movements of one or both hands, followed by atrophy of small hand muscles such as the thenar and hypothenar eminences and interosseous muscles. In severe cases of atrophy, the patient's hands may take on a claw-like appearance. In a minority of patients, muscle atrophy and weakness may begin in the lower limbs or trunk muscles. As the disease progresses, muscle weakness and atrophy can spread to the forearm, upper arm, and scapular muscle groups, then to the trunk and neck, and finally to the facial and pharyngeal muscles. ALS remains an incurable disease, but there are many ways to improve patients' quality of life and delay disease progression. Early diagnosis and treatment, along with timely neuroprotective and supportive therapies, are essential.