Key takeaways
- Early ALS symptoms can include muscle twitching, stiffness, or weakness.
- However, some evidence suggests that older females may be more likely to have symptoms affecting the face and neck muscles. This is known as bulbar onset ALS.
- Bulbar onset ALS has links to a shorter survival time, so anyone with symptoms that could be ALS should speak with a doctor, especially if they are affecting the head.
Amyotrophic lateral sclerosis (ALS), formerly known as Lou Gehrig’s disease, is a chronic condition that affects motor neurons, which are responsible for controlling muscle movements.
According to the ALS Association, the condition is 20% more common in men than in women, but the prevalence becomes equal as women age.
Learn more about the early possible signs of ALS in females, as well as what you can expect in terms of diagnosis, treatment, and outlook.
The use of binary terms such as “male” and “female” or “men” and “women” in this article reflects the language of the sources we’ve used. Unless otherwise noted, it’s unclear whether the research we reference included participants with expansive gender identities.
In general, some of the earliest signs of ALS in anyone may include muscle symptoms such as:
- weakness
- twitching
- cramps
- stiffness
However, the prevalence of these symptoms may differ by sex and age group.
A 2021 study reported that female adults who develop ALS before age 60 tend to have limb onset types, while bulbar onset ALS becomes significantly more common over 60, although limb onset is still the most prevalent overall.
Limb onset ALS causes more muscle weakness in the arms and legs, while bulbar onset ALS affects the face and neck.
Overall, around
Researchers are still looking into the ways ALS first shows up differently depending on sex.
There’s no exact timeline for ALS progression after the first stage. While the average survival rate is 3 years after symptoms start, ALS can progress more quickly or more slowly than this.
However, a study from 2025 says that bulbar onset ALS may develop rapidly compared with other types.
Since bulbar onset ALS tends to be an
An accurate diagnosis that rules out other conditions is also important because bulbar onset ALS sometimes mimics other nervous system conditions, such as multiple sclerosis and myasthenia gravis. These conditions have different treatments and different outlooks.
Diagnosing ALS may involve the following:
- physical exam
- blood and urine tests
- magnetic resonance imaging (MRI)
- a nerve conduction study
- electromyography (EMG)
Regardless of the type of ALS a doctor diagnoses you with, a treatment plan usually involves a combination of medications and therapies. These
- edaravone (Radicava)
- riluzole (Rilutek)
- tofersen (Qalsody)
- speech therapy
- occupational therapy
- physical therapy
- nutritional support
- a low impact exercise program
The outlook for ALS can vary a lot depending on the type of symptoms you have and how quickly they progress.
The median survival time for all forms of ALS is
- mild obesity at the time of diagnosis
- younger age when the symptoms began
- limb rather than bulbar symptoms
- better forced vital capacity, which is a lung capacity measurement
- better scores in a test known as the ALS Functional Rating Scale
However, none of these factors is a guarantee, as the exact timeline is highly individual.
Females below the age of 60 are less likely to develop ALS, but their risk becomes the same as males as they age. They are also more likely to develop bulbar onset ALS over this age, which has associations with a shorter survival time.
Because of this, it is important to be aware of the potential symptoms of ALS and to get medical advice if any appear.
If you start experiencing unusual muscle weakness or twitching that affects your ability to speak, eat, or walk, you should speak with a doctor right away. The sooner a doctor diagnoses ALS, the sooner you may begin treatment.