Amyotrophic lateral sclerosis (ALS), often referred to as Lou Gehrig’s Disease after the famed 1930s New York Yankees player, is a progressive neurodegenerative disease that continues to challenge scientists and impact thousands of lives each year. May is recognized as ALS Awareness Month, offering an opportunity to raise awareness, deepen public understanding, and support ongoing research and care.What is ALS?ALS targets motor neurons—nerve cells in the brain and spinal cord responsible for voluntary muscle movement. When these neurons degenerate and die, the brain can no longer communicate with muscles, leading to muscle weakness, paralysis, and eventually respiratory failure. Most individuals with ALS retain their cognitive function, but lose the ability to walk, speak, eat, and breathe without assistance. The disease progresses over time, with most patients surviving between two to five years following diagnosis.ALS presents in unique ways from person to person. It can begin in the limbs (limb-onset) or in muscles related to speaking and swallowing (bulbar-onset). While no cure currently exists, treatment advancements have offered hope for improved quality of life and extended survival.Who is Affected by ALS?ALS can affect anyone, though it is most commonly diagnosed between ages 40 and 70. According to the CDC, around 5,000 new cases are diagnosed annually in the United States, with about 30,000 people living with the disease at any given time.There are two major types of ALS:Sporadic ALS: This is the most common form, accounting for 90% of cases. Though it appears without family history, a portion of cases may involve genetic mutations.Familial ALS: Representing about 5% to 10% of cases, this inherited form results from specific genetic changes.Certain groups are at higher risk. Military veterans and firefighters are nearly twice as likely to be diagnosed with ALS—potentially due to environmental exposures, physical trauma, or toxins encountered during service. The U.S. Department of Veterans Affairs recognizes ALS as a service-connected condition, entitling veterans to specialized care and benefits.Recognizing SymptomsSymptoms of ALS can vary widely but often begin with muscle weakness, cramps, twitching, or difficulty with speech or swallowing. As the disease progresses, individuals may experience:Spasticity and exaggerated reflexesMuscle atrophy, particularly in the hands and legsBulbar symptoms like difficulty speaking (dysarthria) or swallowing (dysphagia)Emotional lability (pseudobulbar affect)Breathing difficultiesWhile ALS primarily affects motor function, cognitive or behavioral changes occur in up to 50% of patients. Around 10% to 15% may develop frontotemporal dementia (FTD).Causes and DiagnosisThough the exact cause of ALS remains unknown, genetic factors play a key role in some cases. Mutations in genes such as SOD1, C9orf72, FUS, and TARDBP are linked to the disease. Environmental triggers—like toxin exposure, viral infections, and intense physical activity—are also being studied.ALS is diagnosed by ruling out other conditions through clinical evaluation, EMG tests, genetic screening, and imaging such as MRI. Early diagnosis is essential to access therapies and plan care.There is no cure for ALS yet, but treatments like riluzole, edaravone, and tofersen (for those with SOD1 mutations) can slow progression. Promising research areas include gene therapy, RNA-targeted treatments, biomarkers like Neurofilament Light Chain, and artificial intelligence for diagnosis and personalized care.