ALS—a rare, progressive neurological disease—affects motor neurons, thus impacting voluntary muscle movement. An early diagnosis is important for those with ALS, as it can help to establish treatment needs. Helpful medications can be used to treat ALS such as Edaravone, Radicava, Riluzole, and Relyvrio, despite the disease being fatal and having no known cure. Still, the aforementioned medications can help to control symptoms and possibly slow the disease’s progression. Before any of these medications can be administered, however, it’s important to know about some of the early warning signs of ALS. Keep reading to learn more:

1. Slurred speech

Speech may begin to slur early on for those with ALS. Slow, labored, slurred speech and a voice that is hoarse or breathy—also known as dysarthria—is commonly caused by the tightening and weakening of muscles such as the lung muscles. This is another symptom that is associated with ALS, so 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

Abnormally tightened and stiffened muscles may come as a result of nerve loss. This is a symptom associated with ALS, otherwise known as spasticity. While muscle discomfort may occur as a result of strain or physical—or as a result of other conditions—it can also be an early warning sign of ALS to look out for.

3. Difficulty walking

Due to weakening muscles—especially in the ankles, legs, or feet—some individuals with ALS may notice early on that they have difficulty walking, which might result in tripping and falling more often. Additionally, a feeling of clumsiness may be associated with ALS. While everyone can be clumsy from time to time, it’s likely worth keeping an eye on if you suspect that you or your loved one may have ALS.

4. Difficulty chewing and swallowing

There might be some difficulty with chewing and swallowing food in the early stages of ALS. This symptom may become worse as the disease progresses and thus 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

Those with ALS may notice that they are having some trouble breathing in the initial stages of the disease. This can eventually progress into dyspnea—also known as an intense shortness of breath. Eventually, those with ALS will lose the ability to breath on their own and will therefore develop a ventilator dependency.