• ALS is a disease that affects the brain."Charles Bell: Anatomy of the Brain, c. 1802" is Copyrighted by Flickr user: brain_blogger (Shaheen Lakhan) under the Creative Commons Attribution license.
  
  

Bulbar onset ALS

• Bulbar onset ALS is more likely to affect the tongue than limb onset. Many nerves of the face are located in the medulla or bulb, the lower part of the brain. If there is a problem with this area due to ALS, the nerves will be affected, resulting in a condition known as spastic bulbar palsy.
  
  

Spastic Bulbar Palsy

• Spastic bulbar palsy affects the tongue and facial nerves in such a way as to make it difficult to swallow, chew, or speak. The tongue itself may actually develop tremors or a wavy pattern. Drooling might also be present.
  
  

Medical Intervention

• Although the face and tongue often show the first symptoms in bulbar onset ALS, they may also present in limb onset ALS. Patients with ALS often works with an otolaryngologists (ear, nose, and throat specialists) to assist with speech, drooling, and swallowing. Otolaryngologists are often the first physicians to work with ALS patients.
  
  

Incidence of ALS

• The average age of onset for ALS is 55 to 60. The rate of incidence is 1.6 cases per 100,000 people. The prognosis for ALS is 50% survival after three years. After five years, the survival rate is 20%, and decreases to 10% after ten years.
  
  

Highest Incidence

• While ALS affects people in all areas of the world, there are some parts of the globe where its incidence is much higher. These areas are Guam, the Mariana Islands, and the Kii Peninsula of Japan. It is also much more likely for men to be diagnosed with this disease than women.