Lou Gehrig's Disease

The 7 Stages of ALS

A diagnosis of ALS can lead one spiraling down a rabbit hole of fear and uncertainty. Before we talk about the 7 stages of ALS, let me first say that thanks to greater awareness and support, research continues to find new ways of treating this vicious disease including new treatment options for the first time since 2017.  

What is ALS? 

Amyotrophic Lateral Sclerosis, abbreviated as ALS is a progressive neurodegenerative disorder. The 7 stages of ALS begin with muscle weakness or stiffness and typically follow a predictable path to full paralysis. In this article, we will focus on each of the stages of ALS progression.  

ALS Symptoms 

ALS usually begins in the muscles of the hands, arms, feet or legs. The disease progresses through the 7 stages of ALS as the muscles get weaker, extending to other areas of the body. ALS is initially pain-free and eventually leads to total paralysis. 

Why is ALS Called “Lou Gehrig’s Disease”? 

On July 4, 1939, during what is considered to be the most famous speech in baseball history, one of Major League Baseball’s most beloved players, New York Yankee first baseman Lou Gehrig, stated that he felt he was the luckiest man alive. Just two weeks earlier, Gehrig had been diagnosed with ALS after suffering symptoms such as loss of coordination, diminished strength and falling on the baseball field. He progressed through the 7 stages of ALS and died June 2, 1941, at the age of 36.  

In 2021, Major League Baseball designated June 2 as National Lou Gehrig Day, bringing awareness and support to this horrible disease. 

The 7 Stages of ALS 

While everyone who is diagnosed with ALS will experience their own timeline, the 7 stages of ALS generally follow this pattern: 

Stage 1: Early Stage  

Initial symptoms are often overlooked because they tend to be subtle. Muscle weakness, stiffness or mild twitching could be attributed to other issues and often delay the diagnosis of ALS. Early symptoms also include slurred speech, muscle cramping, fatigue and poor balance. 

Stage 2: Diagnosis Stage  

The mild symptoms of stage 1 become more noticeable as there is marked weakness which begins to attack muscle groups. Because of the progression of symptoms, stage 2 is more often than not when a diagnosis is made. While most ALS patients still manage to be independent, daily life and activities begin to be affected. 

Stage 3: Moderate Stage  

At this stage, fatigue becomes more pronounced. Daily activities, mobility and independence become much more difficult and may require assistance and assistive devices. Other symptoms such as paralysis, breathing issues, and trouble swallowing, eating and chewing could also develop at this stage. 

Stage 4: Severe Stage  

The ALS patient requires help with daily living as muscles weaken significantly and mobility becomes increasingly difficult. Ordinarily, at this stage, mobility aids, such as wheelchairs or scooters, become a necessity.  

Stage 5: Critical Stage  

Weakness progresses to the vocal and facial muscles making communication difficult. Assistance from a caregiver becomes necessary for daily tasks. 

Stage 6: Near Total Paralysis 

While there may still be limited muscle function, at this stage ALS patients are at near-total paralysis. Speaking becomes grueling and assistive speech devices may be necessary.  

Stage 7: End Stage  

This is the final stage of ALS where patients require full-time care because they are usually completely paralyzed and unable to speak. They also need assistance with eating and breathing, possibly requiring a ventilator. Most ALS patients die from respiratory failure.  

How Long Does ALS Last? 

ALS is progressive, and it is important to note that the timeline of the disease and each stage can vary. Some patients may experience a slow progression, while others will go through the 7 stages of ALS more quickly. End-stage ALS can last from weeks to several months. 

ALS Life Expectancy 

According to ALS.org, the average life expectancy for those diagnosed with ALS is three years, although about 20% of ALS patients survive five years, 10% live for 10 years and 5% live at least 20 years after diagnosis.  

It is important to mention that quality of life can be greatly improved with medical treatments, medications and care. Great strides have been made in the fight against ALS and there are new options available including the first new FDA-approved drugs since 2017, genetically targeted therapy, wearable sensors and brain-computer interface technology. Discuss treatment plans with your medical professional to find what’s best for you or your loved one.  

 

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