The progression of ALS can vary from person to person, so symptoms may present differently among individuals in the initial stages. While ALS doesn’t have a cure, the drug edaravone can be administered both by mouth and by intravenous infusion to prevent nerve damage and therefore slow the progression of ALS. Riluzole, a drug taken by mouth, can also be prescribed to treat ALS and increase life expectancy by around 25%. Additionally, various therapies can be provided to treat ALS such as speech therapy, respiratory therapy, occupational therapy, and whirlpool or heat therapy. If you believe that you or a loved one may have ALS, here are some early warning symptoms to look out for:

1. Slurred speech
For those with ALS, speech may begin to slur early on. Dysarthria—slow, labored, slurred speech and a voice that is hoarse or breathy—is commonly caused by the tightening and weakening of muscles such as the lung muscles, another symptom that is associated with ALS. If you begin to notice signs of slurred speech, it may be time to get in touch with a medical professional.

2. Tight, stiff muscles
Losing nerves results in abnormally tightened and stiffened muscles. This is otherwise known as spasticity, a symptom associated with ALS. While muscle discomfort may occur as a result of multiple other conditions—or even as a result of physical exercise or strain—it can also be an early warning symptom of ALS to look out for.

3. Difficulty walking
Some individuals with ALS may notice early on that they have difficulty walking due to weakening muscles—especially in the ankles, legs, or feet—which may lead to tripping and falling more often. A feeling of clumsiness may be associated with ALS as well and, while everyone can be clumsy from time to time, it might be worth keeping an eye on if you suspect that you or your loved one may have ALS.

4. Difficulty chewing and swallowing
In the early stages of ALS, there might be some difficulty with chewing and swallowing food. As the disease progresses, this symptom may become worse and result in dysphagia, a term used to define swallowing difficulties. Dysphagia can range anywhere from having trouble swallowing certain foods to being unable to swallow at all. Bringing food back up after swallowing, occasionally through the nose, as well as choking and coughing while eating, can also occur for those with dysphagia.

5. Difficulty breathing
Initially, those with ALS may notice that they are having some trouble breathing. Eventually, this can progress into dyspnea, which is an intense shortness of breath. Those with ALS will lose the ability to breath on their own and will therefore need to depend on a ventilator.