The first signs of Motor Neurone Disease (MND) vary but commonly include muscle weakness (causing stumbling, dropping things, weak grip), muscle cramps or twitching (fasciculations), and problems with speech (slurring) or swallowing (dysphagia). Fatigue and subtle changes in dexterity or coordination can also be early indicators, often starting in the limbs, hands, or feet, but sometimes affecting the throat muscles first.
In 1 out of 4 cases, the first MND symptoms will affect the muscles used for speaking and swallowing. These problems might initially affect the muscles used for speech and swallowing. Increasingly slurred speech (dysarthria) is usually the first sign of this type of MND. It might be misdiagnosed as a stroke.
In 1963, while a graduate student at the University of Cambridge, Hawking began experiencing early symptoms of ALS, such as muscle weakness and slurred speech. These initial manifestations rapidly progressed, leading to a diagnosis that came with a grim prognosis—2 years to live.
MND symptoms usually begin as mild weakness in your lower body; they gradually worsen and spread to your upper body, causing paralysis and breathing difficulties. In rare cases a genetic mutation can cause MND, but usually there is no known cause.
The latency from symptom onset to diagnosis in MND documented in the literature has shown little improvement or change over the last 40 years and figures range from 10.6–17.5 months3–13.
stiff or weak hands – you may have problems holding or gripping things. weak legs and feet – you may find climbing stairs difficult, you may trip over a lot and you may find it hard to lift or move your foot (foot drop) twitches, spasms or muscle cramps (where muscles painfully tighten)
Weakness. Progressive muscle weakness is a feature of MND, but can be variable in its severity, progression and distribution. In the lower limbs it may present as foot drop, a tendency to trip, difficulty in rising from chairs and excessive fatigue on walking.
Most people experience the onset of symptoms after the age of 40 years and MND is most common in people aged between 50 and 70 years. Although rare, for some people there is a genetic factor and they inherit from their family an increased risk of developing MND.
Early signs of ALS often involve painless muscle weakness, such as tripping or dropping things, along with muscle twitching (fasciculations), cramping, and stiffness (spasticity), commonly starting in limbs but sometimes affecting speech (slurring) or swallowing (choking). Other early indicators include significant fatigue, poor balance, or even uncontrollable laughing/crying (pseudobulbar affect). These symptoms usually begin subtly in one area and spread, affecting daily activities before becoming severe.
Some of the more common conditions that can mimic MND include:
Early signs of ALS often involve painless muscle weakness, such as tripping or dropping things, along with muscle twitching (fasciculations), cramping, and stiffness (spasticity), commonly starting in limbs but sometimes affecting speech (slurring) or swallowing (choking). Other early indicators include significant fatigue, poor balance, or even uncontrollable laughing/crying (pseudobulbar affect). These symptoms usually begin subtly in one area and spread, affecting daily activities before becoming severe.
Stephen Hawking's "last warnings" focused on humanity's existential risks, urging us to become a multi-planetary species to survive threats like climate change, asteroids, and rogue artificial intelligence (AI). He warned that unchecked AI could surpass human intelligence, potentially replacing us, and emphasized the need to colonize other planets before Earth becomes uninhabitable due to self-inflicted or natural disasters, as detailed in his posthumous book Brief Answers to the Big Questions.
Vitamin B12 deficiency can mimic ALS, particularly in its presentation of weakness, numbness, and balance problems. Both conditions can affect the nervous system and lead to muscle weakness and neurological symptoms.
How is MND diagnosed?
The exact cause of Motor Neurone Disease (MND) is unknown, but it's believed to result from a complex mix of genetic predisposition, environmental factors (like toxins or intense exercise), and lifestyle influences, with most cases being sporadic (no known cause) and only 5-10% being familial (inherited). Researchers are exploring potential triggers such as genetic mutations (like C9orf72, SOD1), heavy metals, pesticides, viruses, and issues with cellular waste disposal or nerve signaling.
Nutrients. There is some evidence that motor neurones become more likely to develop MND because of a lack of nutrients. One form of such nutrients is a group of chemicals called 'neurotrophic factors' (meaning 'nerve nourishing factors').
Nasal inspiratory pressure during a sniff (SNIP) is a respiratory test extensively promoted in Amyotrophic Lateral Sclerosis (ALS) for the assessment of the inspiratory muscle strength.
ALS often starts in the hands, feet, arms or legs. Then it spreads to other parts of the body. Muscles get weaker as more nerve cells die. This eventually affects chewing, swallowing, speaking and breathing.
The first signs of Motor Neurone Disease (MND) often involve muscle weakness, leading to stumbling, a weak grip, or difficulty lifting objects, but can also start with speech/swallowing issues (slurring, choking) or muscle twitching (fasciculations) and cramps. These symptoms are usually mild and painless initially, varying by where the motor neurons are first affected, but often include fatigue and affect limbs or speech/swallowing muscles.
Progression of symptoms over time provides evidence to support the diagnosis. Many of the people we talked to had been experiencing symptoms for months or even years before finally getting a diagnosis.
Professor Hawking lived with motor neurone disease for 55 years having been diagnosed at the age of 21 while at university, a story told in the 2015 Oscar winning film The Theory of Everything.
Neuromuscular diseases
They include muscular dystrophy, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), myasthenia gravis and fibromyalgia. These diseases cause several symptoms, including losing strength in the legs, muscle twitching and muscle stiffness.
Symptoms in arms and hands
Some people had first noticed weakness or stiffness in their arms or hands. Sometimes this was accompanied by aching or cramps. (MND is generally not a painful condition, but muscle stiffness can be uncomfortable at times).
Tingling or pins and needles are associated with some neurological conditions, but not MND. If these sensations are a constant problem, your GP may still refer you to a neurologist if needed, as there could be other reasons why this is happening.