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