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 indicator of ALS. Dehydration, exercise, medications, electrolyte disturbances, and nerve problems are much more common explanations.
## 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
