Numbness and tingling can be symptoms of amyotrophic lateral sclerosis (ALS), but they are more commonly associated with other conditions. ALS primarily causes muscle weakness from the degeneration of motor neurons in the brain and spinal cord. However, some people with ALS do experience sensory symptoms like numbness and tingling as well.
What is ALS?
ALS, also known as Lou Gehrig’s disease, is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord. It causes the loss of motor neurons that control voluntary muscle movement. As motor neurons degenerate, the brain loses its ability to initiate and control muscle movement.
People with ALS experience muscle weakness, twitching, and eventually paralysis as the disease progresses. ALS is fatal, usually within 2-5 years from the onset of symptoms, as the muscles involved with breathing weaken. However, the disease does not typically impair thinking, personality, intelligence, or memory.
Common initial symptoms of ALS
The early symptoms of ALS often include:
- Tripping or dropping things
- Weakness in the hands, arms, legs or mouth
- Slurred speech or hoarse voice
- Muscle cramps and twitches
- Weight loss due to muscle deterioration
The initial symptoms can be quite subtle and occur across different parts of the body. Numbness or tingling is not a common early symptom of ALS.
Does ALS cause numbness and tingling?
Some people with ALS do experience numbness or tingling, but it is not considered a primary symptom. Up to 55% of people with ALS report experiencing some sensory symptoms like numbness and tingling. However, these sensations are usually mild compared to the more pronounced muscle weakness.
When numbness and tingling do occur with ALS, they are caused by the degeneration of upper motor neurons in the brain. Upper motor neurons send signals down to lower motor neurons in the brainstem and spinal cord, which then signal to muscles. As upper motor neurons degenerate, sensory signals from the body to the brain can be disrupted, leading to numbness or tingling.
The parts of the body most likely to be affected by numbness or tingling in ALS are:
- Hands
- Feet
- Arms
- Legs
These sensations may spread upward in the limbs as ALS progresses. Numbness and tingling can occur on just one side of the body at first but often eventually affects both sides. The face is rarely impacted.
Other causes of numbness and tingling
There are many potential causes of numbness and tingling other than ALS, including:
- Peripheral neuropathy
- Multiple sclerosis
- Fibromyalgia
- Vitamin deficiencies
- Diabetes
- Autoimmune disorders
- Pinched nerve
- Stroke
- Carpal tunnel syndrome
Since numbness and tingling have many possible causes, they cannot be relied upon to diagnose ALS. The presence of progressive muscle weakness and wasting in the absence of sensory loss is more indicative of ALS.
Diagnosing ALS
ALS is generally diagnosed based on:
- Clinical examination to assess muscle strength, reflexes, and presence of twitches/fasciculations
- Electromyography to measure electrical activity of muscles and nerves
- Nerve conduction studies
- MRI and CT scans to rule out other possible conditions
- Blood and urine tests to check for other causes
There are no definitive diagnostic tests for ALS. Doctors need to rule out other conditions that could explain the symptoms. It often takes 12-14 months to diagnose ALS from the onset of symptoms because the disease progresses gradually.
Key features that support an ALS diagnosis
- Progressive worsening of muscle strength and coordination in multiple body regions
- Presence of muscle twitches and wasting
- No changes in thinking and behavior
- No impairment of bowel, bladder or vision
- Abnormal EMG indicative of widespread nerve damage
Treating numbness and tingling in ALS
There are no treatments that can stop the progression of ALS. Management focuses on relieving symptoms and improving quality of life.
If numbness or tingling sensations are troubling, the following options may help provide relief:
- Over-the-counter pain relievers like ibuprofen, naproxen or aspirin
- Prescription medications for neuropathic pain like gabapentin
- Muscle relaxants like baclofen
- Massage and acupuncture
- Applying heating pads or cold packs to affected areas
- Gentle stretching and exercise to improve circulation
- Transcutaneous electrical nerve stimulation (TENS)
It is important that numbness and tingling are evaluated by a neurologist to determine the underlying cause and appropriate management. Non-medication approaches should be tried first when possible.
Coping with ALS
Receiving an ALS diagnosis is extremely difficult. The disease severely impacts quality of life and independence. Proper support and coping strategies can help patients manage their condition:
- Joining a support group to connect with other patients
- Consulting with occupational and speech therapists
- Adapting the home environment to allow greater accessibility
- Using mobility aids like walkers, wheelchairs, and lifts when needed
- Communicating through writing or computer voice systems as speech declines
- Discussing wishes for care and end-of-life decisions
- Participating in clinical trials for experimental treatments
- Focusing on meaningful hobbies and activities
- Maintaining social connections and asking for help from family/friends
- Receiving counseling or antidepressants for depression
While emotionally devastating, ALS progresses slowly, allowing time to seek support and adapt to limitations. Patients and families should reach out to their healthcare team and support organizations to improve quality of life.
The takeaway
In summary, while some people with ALS experience numbness and tingling, these are not considered primary symptoms of the disease. They are caused by degeneration of upper motor neurons in the brain disrupting sensory signals.
The hallmark symptoms of ALS are progressive muscle weakness, wasting, and twitches that reflect the loss of lower motor neurons. Since numbness and tingling have many possible causes, they do not help confirm an ALS diagnosis.
Managing troubling numbness or tingling involves medications, therapeutic techniques, and lifestyle changes. Supportive care is key for helping ALS patients cope with their prognosis and maximize quality of life. While currently incurable, ongoing research provides hope that more effective treatments for ALS are on the horizon.