Hey there,
To answer your question, ALS never-ever presents itself as a body wide muscle twitching.
It usually starts distally when it's Limb-onset (the muscles that are farther from your body such as hand muscles or foot muscles).
Furthermore, muscle twitching is NOT the very first manifestation of the disease.
It first starts with, for example hand weakness. You do notice this when you try to do tasks that you normally do without putting up too much effort (Examples: opening a jar, lifting a gallon of milk, turning a car key, turning a door knob, etc.) All these should be easy tasks for somebody with no weakness. You no longer can do any of these tasks.
After a while when the weakness sets in, then is when you start noticing muscle twitches also known as Fasciculations which indicates that the Motor Nerves that control this group of muscles are starting to sever connections.
Finally, after all described above has happened, then is when you notice muscle ATROPHY.
The muscle is gone forever leaving you with an atrophied limb you can no longer use.
I hope this helps.
NH
