Which onset pattern is associated with faster progression in ALS?

• A. Bulbar onset
• B. Limb onset
• C. Respiratory onset
• D. Ocular onset

Answer: (A)

Bulbar onset tends to predict a faster disease course in ALS. When the muscles involved in speaking, swallowing, and airway protection are affected early, patients typically develop dysarthria and dysphagia sooner, which raises risks of malnutrition, dehydration, and aspiration. These problems hasten respiratory decline and overall functional loss, leading to shorter survival compared with limb-onset ALS, where weakness starts in the limbs and bulbar/respiratory involvement comes later. Ocular onset is not characteristic of ALS, and respiratory onset, while possible, is less common and does not define the faster trajectory the way bulbar onset does.