"The Hawking Curse": Sudden loss of strength in the hand – what lies behind the first signs of ALS

It often begins with minor neurological deficits in the hand or foot, which can also indicate many other neurological diseases – but in the case of amyotrophic lateral sclerosis, or ALS for short, the long-term result is severe paralysis.

ALS is a neurodegenerative disease of the motor nervous system. Its cause remains unknown. Typical symptoms include loss of endurance, muscle fatigue, seizures, reduced fine motor skills, and speech disorders.

Neurologist Dr. Mimoun Azizi, MA, has been the Managing Chief Physician and Head of the Center for Geriatrics and Neurogeriatrics at the Southwest Hospital Association (KVSW) since April 1, 2025. He is also a specialist in psychiatry and psychotherapy and holds additional qualifications in emergency medicine, geriatrics, and palliative medicine. The author of numerous specialist books and articles, he also holds a master's degree in political science and sociology and a master's degree in philosophy.

Amyotrophic lateral sclerosis (ALS) is a progressive disease of the nervous system in which the nerve cells responsible for muscle movement are gradually destroyed. Initial symptoms usually appear in the arms or legs and include muscle weakness, muscle twitches, cramps, lack of strength, and problems with fine motor skills.

Muscle stiffness or difficulty speaking, chewing, and swallowing can also occur. The disease primarily affects people between 50 and 70 years of age, slightly more frequently in men than in women. In rare cases, symptoms of dementia also occur. As the disease progresses, muscle strength continues to decline, which also affects the respiratory muscles – many affected individuals die of respiratory failure, often within three years. However, there are exceptions with longer survival times, such as the astrophysicist Stephen Hawking.

There is currently no cure for ALS, but medication and symptomatic treatments are available. Medications such as riluzole or (in some countries) Radicava can slow the progression of the disease, especially if started early. Regular monitoring is important, as side effects can occur.

Symptomatic therapy aims to alleviate symptoms and maintain quality of life for as long as possible. This includes assistive devices, respiratory support, feeding via a nasogastric tube for swallowing difficulties, and medications to combat excessive salivation. Accompanying psychological symptoms such as depression or anxiety are also treated.

Physiotherapy, massage, and electrotherapy also help promote mobility. Since many patients are less active, thrombosis prophylaxis is also important. Overall, a great deal of individualized support and ongoing research are needed to better help those affected.

This article is from the EXPERTS Circle – a network of selected experts with in-depth knowledge and many years of experience. The content is based on individual assessments and is aligned with the current state of science and practice.