Amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s disease, is a type of motor neuron disease. The condition damages the motor neurons, which control muscle movement in a person’s body. It is often a fatal condition, although some treatment options can help some people with ALS cope with the disease.

ALS is not a common condition. One 2020 study notes that only 5.2 in every 100,000 people in the United States are affected by the disease.

According to the ALS Association, ALS is a progressive condition.

However, there are no set stages of ALS, with the progression of symptoms depending on the individual.

This article will explore the main kinds of ALS and its typical stages. It will also discuss what might cause the condition, along with diagnosis and treatment options.

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If symptoms begin in the arms or legs, doctors refer to this as “limb onset ALS,” However, if the disease starts affecting speech or swallowing, they call it “bulbar onset ALS.”

These symptoms usually begin when a person is in their 50s or early 60s.

Although there is no linear progression of ALS, early symptoms may include:

As these symptoms affect the muscles, they may hinder a person’s ability to perform everyday tasks. For example, individuals may find themselves tripping, dropping things, or unable to button clothing.

The muscle changes that a person may experience during the early stages of ALS can worsen during the middle stages of the condition. This means that symptoms can also affect other parts of the body.

During this stage, a person may experience:

In the condition’s final stages, a person will find that nearly all of their muscles are paralyzed, including the mouth and throat muscles. This means that talking, eating, and drinking are impossible. People can receive food and drink via a tube.

A person may also experience the following complications:

Frontotemporal dementia

Up to 15% of people with ALS develop symptoms of a second brain disorder called frontotemporal dementia (FTD). It is a progressive condition that affects personality, speech, and behavior. Similarly, some people initially diagnosed with FTD develop symptoms of ALS as their FTD progresses.

Learn about frontotemporal dementia here.

Currently, there is no cure for ALS. According to the ALS Association, the average survival time is 3 years.

Following diagnosis, 20% of those with ALS will live for 5 years, and 10% will live for 10 years.

Approximately 5% of people with ALS will live for 20 years or more after diagnosis.

However, most people will pass away from respiratory failure within 2–10 years.

In a 2020 study, scientists described two broad types of ALS: spinal onset ALS and bulbar onset ALS. The former is sometimes called limb onset ALS.

Around 70% of people with ALS have spinal onset ALS, while 25% of people with the disease have bulbar onset ALS. Spinal onset ALS also tends to progress less quickly than bulbar onset ALS.

Spinal onset ALS

Spinal onset ALS occurs when the disease begins by affecting the motor neurons in a person’s limbs. People with this ALS type will start to experience weakness in their hands, arms, or legs.

Bulbar ALS

Bulbar onset ALS occurs when the disease starts affecting the motor neurons in an individual’s head. Those with this ALS type will begin to experience difficulties with speech or swallowing food or drink.

Learn about the different types of ALS here.

No one knows how ALS precisely works or what triggers it. However, scientists have discovered some factors that might make a person more likely to develop the condition.


As one 2017 study notes, genes can play a part in a person developing ALS. Having a parent with the disease increases the likelihood of developing it. However, the genetic component only accounts for 5–10% of U.S. cases.


The same 2017 study explains that environmental factors may also lead to ALS.

Some factors that could make a person more likely to develop the disease include:

  • smoking
  • previous deployment as military personnel
  • high volumes of physical activity
  • exposure to chemicals such as pesticides and heavy metals
  • exposure to electric shock
  • experiencing physical trauma, especially head injuries

However, the evidence for these environmental causes is mixed.

For example, nobody knows whether high volumes of exercise can cause ALS. It might instead be the case that people who are very active are also more likely to develop the condition. There is no evidence that reducing a person’s physical activity lowers their chances of developing ALS.

It is also important to note that this study only involved participants from the U.S.

No cause

If the ALS does not have a cause, it is called sporadic ALS. Sporadic ALS affects 90–95% of people diagnosed, making it the most common type of ALS in the U.S.

To diagnose ALS, doctors will typically consider an individual’s test results and medical history.

As a 2018 study explains, ALS is difficult to diagnose, and doctors often rule out other conditions that mimic its symptoms before making an official diagnosis of ALS.

To do so, doctors may use the following tests:

There is no known cure for ALS. However, some treatment options are available to help ease symptoms.


According to the National Institute of Neurological Disorders and Stroke, doctors may prescribe medications, such as riluzole (Rilutek) or edaravone (Radicava), to reduce damage or slow progression of the disease.

Physical therapy

Physical therapy can strengthen a person’s unaffected muscles, which can help them remain independent.

For example, people could take part in the following forms of low impact aerobic exercise:

Exercising may also help a person manage the mental challenges and fatigue an ALS diagnosis can bring.

Managing symptoms

As a 2020 study explains, treatment for ALS focuses on managing the disease’s symptoms and improving overall quality of life.

Doctors can also use certain treatment methods to manage the following symptoms:

Breathing difficulties

As ALS progresses, breathing becomes more difficult.

People with ALS may need ventilators to help them breathe, especially during the later stages of the disease.

Eating difficulties

Those with ALS also experience increasing difficulties chewing and swallowing their food. This means that individuals with the condition can benefit from eating high energy foods, which helps prevent excessive weight loss.

Eventually, however, people with ALS may need to use tubes to ingest food.

Talking difficulties

A speech therapist can help a person with ALS speak louder or more clearly if the condition affects how they talk. This can be invaluable in maintaining a level of independence and maintaining communication with a person’s support system.

A speech therapist can also recommend speech aids a person can use, such as eye-tracking technology or voice banking.

Learn about speech therapy here.

Mental health challenges

Because ALS involves such severe and painful symptoms, a person may face challenges with their mental health.

Talking with a doctor or psychologist about seeking therapy or alternative treatments may benefit a person with this condition.

Learn more tips about living with ALS here.

ALS is a serious progressive disease with no known cure.

While there are no set stages of the condition, early stages of the disease can involve muscle twitching or weakness. Middle stages may include muscle paralysis or loss, while later stages lead to complications such as respiratory failure.

Different treatment options, including mental health support, can help some people manage their lives with ALS.

Anyone with symptoms of ALS should seek the advice of medical health professional.