Progressive speech impairment as the first manifestation of amyotrophic lateral sclerosis: Case report and literature review

Amyotrophic Lateral Sclerosis (ALS) is a rare neurodegenerative disease with an incidence of 1.59 per 100,000 people per year. It is characterized by the progressive loss of upper and lower motor neurons, leading to muscle weakness, neuromuscular dysfunction, and eventual severe disability. This case report presents a 62-year-old male patient from Tarapoto who initially exhibited progressive dysarthria as his sole symptom. Two months later, he developed dysphagia for solids and liquids and weakness in his right lower limb. The diagnosis of ALS was established using the revised El Escorial and Awaji-Shima criteria, supported by electromyography findings indicative of acute denervation and chronic reinnervation in multiple segments, including bulbar and thoracic areas. Complementary studies, such as brain tomography, revealed cortico subcortical frontoparietal atrophy without significant findings suggesting other associated pathologies. The patient’s management included physical and speech therapy over multiple sessions, resulting in mild improvements in dysarthria and dysphagia, allowing greater fluency in speech and better tolerance to liquid intake. However, specific pharmacological therapies for ALS, such as riluzole, edaravone, or mitochondrial dysfunction-targeted combinations, were unavailable, limiting the potential to delay disease progression. During his evolution, the patient developed episodes of bronchitis treated with antitussive and mucolytic therapy, with no significant pulmonary complications. Bulbar phenotype ALS, present in 25–30% of cases, poses a diagnostic challenge due to its variable clinical presentation and inevitable progression. This case highlights the importance of comprehensive, multidisciplinary management, including early interventions to address physical, psychological, and social symptoms, as well as palliative strategies to optimize the quality of life for the patient and their family. Although non-pharmacological therapy achieved partial improvements, early access to approved treatments and specialized resources could have provided greater functional and survival benefits.