Gradual onset and painless, progressive muscle weakness is the most common early ALS symptom. Other early symptoms of ALS vary, but may include tripping, dropping things, abnormal fatigue of the arms or legs, slurred speech, muscle cramps and twitches, and/or ... Lou Gehrig's Disease: Early Symptoms www.lifescript.com/health/briefs/l/lou_gehrigs_disease_early_symptoms.aspx. about.