How common is bulbar syndrome?

Bulbar symptoms (including speech and swallowing difficulties) are the first symptom of ALS in 30–40% of all affected individuals. If bulbar symptoms are the initial presentation, the disease is referred to as “bulbar ALS.” Even in patients whose initial symptoms involve the extremities or trunk, 75–80% of patients develop a bulbar syndrome as the disease progresses. The extent of involvement varies greatly. In bulbar ALS, the bulbar syndrome is pronounced, whereas in other forms of ALS, the bulbar syndrome may remain less pronounced. Overall, the bulbar syndrome, along with paresis and myatrophy of the extremities and trunk, is one of the key hallmarks of ALS.