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Q. In ALS, are symptoms present on both sides of the body?

Answered by
Dr. Ashok Kumar Choudhary
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jul 08, 2017 and last reviewed on: Jul 31, 2019

Hello doctor,

I am a 45 years old female. I first experienced my symptom 18 years ago, which was left-hand side symptom. I have seen two neurologists since the last visit along with MRI was seven years back. My main concern back then was MS, but the last neurologist said it is not MS. I raised my concerns of ALS, but my MRI was normal. I have again got symptoms back and have had a fall, in which the left leg just gave away a few weeks ago. However, this time, l also seem to have muscle spasms on right side and right thumb twitching. I am extremely anxious and waiting to see a neurologist again. I have had an MRI done again a few days ago, and my GP said my report came back as 'no significant abnormalities.' Can ALS present with symptoms for this many years but still not show on an MRI? And with ALS, do symptoms present on both sides of the body? My GP said l have somatization disorder, which was diagnosed after the last neurologist visit. I would greatly appreciate your input.

Dr. Ashok Kumar Choudhary

Andrology Geriatrics Psychiatry Psychologist/ Counsellor Psychotherapy Sexology


Welcome to

I read your query and understand your concerns.

  • I can state with 100 % confidence that no ALS (amyotrophic lateral sclerosis) presents over the 18 years. It is a progressive illness and once started, there is gradual deterioration. As symptoms experienced by you are of episodic nature, the chances of ALS are characteristically nil.
  • Since ALS is a chronic disorder, it initially presents with one-sided weakness and atrophy, but over time, the symptoms and signs are seen on both side of the body and there is a symmetric presentation.

I hope this answers you. Feel free to write back to me if you have more questions. Thanks and regards.

For more information consult a neurologist online -->

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Hi doctor,

Thank you so much for your reply. It has put me somewhat at ease. l guess my concern remains that I have heard ALS symptoms have been seen years earlier, hence my concern. My other concern is that on the left-hand side two years ago, I got numbness, spasms, and now wasting of some muscle around my left knee. My left leg is thinner than my right. I have now got muscle spasms on the right-hand side as said before and very noticeable thumb and index finger twitches. Has no one ever had years of symptoms before any real clinical abnormalities are noted? Thank you again.

Dr. Ashok Kumar Choudhary

Andrology Geriatrics Psychiatry Psychologist/ Counsellor Psychotherapy Sexology


Welcome back to

Thanks for the follow-up.

  • Regarding your post, the current symptoms in form of atrophy, asymmetrical atrophy, in particular, twitches and numbness can present with ALS, but as per my knowledge, no one has symptoms years earlier than the clinical presentation. It is rightly possible that all episodes are not related to the current presentation if it is ALS.
  • However, I like to reassure you that before calling it ALS or a related disorder, we need to understand that complete neurological evaluation should be made. ALS have a varied presentation, and only the neurological examination can shed light on it and other disorders.
  • We have clear evidence about having least possibility of ALS in your case and need to have your anxiety under control, as it could be another reason for twitches and numbness.

I hope this reassures you further. Thanks and regards.

For further queries consult a neurologist online -->

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