The neurological illness that whispers before it shouts
Most famous for portraying Dr. Mark Sloan on the hit TV show Grey’s Anatomy, Eric Dane, 52, announced in April that he was diagnosed with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.
ALS is a slow progressing disease that doesn’t show symptoms right away. Neurologists say subtle stumbles, like regularly dropping things, can be the earliest clues of ALS.
“Most people picture ALS as dramatic muscle wasting, but the illness often whispers before it shouts,” says Dr. Melissa Cook, a neuromuscular physician at Aurora Health Care. “The sooner we recognize those whispers, the sooner we can slow the disability curve and connect patients to support.”
According to the ALS Association, common early symptoms include:
- Persistent muscle twitches
- Unexplained cramps
- Abnormal fatigue in the arms or legs
- Slurred or nasal speech
- A tendency to drop objects or trip on flat ground
Some people notice handwriting shrinking or becoming shaky, while others experience sudden, uncontrollable laughing or crying.
ALS can start in the limbs (limb-onset) or the mouth and throat muscles (bulbar-onset). Limb-onset ALS may begin with weakness in a single hand or foot. Bulbar-onset can announce itself through hushed, hoarse or slurred speech, or by frequent choking on thin liquids.
“We encourage anyone who has consistent, unexplained muscle twitching lasting more than a month – especially if it’s paired with weakness – to see their doctor,” Dr. Cook adds. “An early evaluation does not equal an ALS diagnosis, but it does rule out simpler problems like a pinched nerve or electrolyte imbalance.”
ALS cannot be confirmed with a single scan and usually takes up to a year to get a proper diagnosis.
Doctors build the diagnosis step by step, using a neurological exam, blood work, electromyography (EMG) and nerve-conduction studies to exclude mimicking conditions, such as thyroid disease, neuropathy or myasthenia gravis.
Muscle twitches are common after intense workouts, associated with anxiety, during periods of high caffeine use or when sleep deprived. They usually vanish with rest, hydration and stretching. Twitches linked to ALS differ because they persist at rest and appear alongside weakness, poor grip strength or noticeable thinning of the muscle (atrophy).
If you are noticing symptoms, Schmeling suggests these steps:
- Track your symptoms: Write down when twitching or weakness occurs, what makes it worse and how long it lasts.
- See your primary care provider: A simple physical exam and blood panel can exclude vitamin deficiencies or thyroid problems.
- Request a neurology referral: If basic tests return normal, yet weakness or speech issues continue, a neurologist can perform EMG testing.
- Lean on support early: Local ALS clinics offer nutrition guidance, mental health counseling and access to clinical trials.
Are you trying to find a neurologist? Find one in Illinois or Wisconsin.
