My wife works In home health, her latest patient had ALS, he passed yesterday, he had it for all of six months, ALS is a brutal disease, two years in you'd KNOW you have it. His symptoms weren't even twitching, in fact he said he didn't know something was wrong until he couldn't hold items anymore. His wife is a neurologist and she suspected ALS only after every battery of tests you can think of. She said the first symptom people rarely notice is intermittent weakness, like your hand slipping when you try to pull the covers up, etc. She said Twitches are a last phase symptom, appearing after the muscles have already started to atrophy.