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How come some people with amyotrophical lateral sclerosis have impaired speech and the others with the same disease not. My close friend has ALS. Hers health is worsening every day. Lately, she almost was not able to speak. I almost cry last time I saw her. Beside this I know that some people has ALS and do not have these symptoms.

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Problem is that there are several types of this disease. In various literatures you may find categorization of this kind: bulbar, cervical, thoracic, lumbosacral. Your friend probably has "bulbar ALS". In this type, ALS affects muscles of speech and swallowing. In some other types of ALS basic symptoms affect thoracic or lumbosacral muscles.
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