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ALS can be phenotypically classified into either limb onset (LO) cases with upper and lower motor neurons being affected, accounting for 70% of the cases, or Bulbar onset (25%) in which speech and swallowing issues first arise that are followed by later stage limb weakness (Zarei et al., 2015)

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After a few weeks he feels a modest improvement in clarity

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10.1542/peds.2007-2361 82 KatoY.YokokuraM.IwabuchiT.MurayamaC.HaradaT.GotoT.et al (2023)