Lou Gehrig’s syndrome: Here are the first symptoms of this disease

can cause similar symptoms. ([Mayo Clinic][1])

## 4. Muscle Twitching

Small involuntary muscle twitches, known as **fasciculations**, are commonly associated with ALS.

They may occur in areas such as the:

* Arms
* Shoulders
* Legs
* Tongue

However, muscle twitching is extremely common and can also happen because of exercise, stress, caffeine, sleep deprivation, or other benign causes.

Twitching becomes more meaningful when it occurs alongside **progressive muscle weakness or wasting**. ([Mayo Clinic][1])

## 5. Muscle Cramps

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

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