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ALS early symptons

Early symptons of ALS
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I am also wondering "Can the early symptoms of ALS fluctuate and be episodic?"??????ANY ONE KNOW????
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Can the early symptoms of ALS fluctuate and be episodic?  Several days with symptoms and maybe 1-3 days with a decrease in symptoms?  Have you heard of knee pain with squating and rising? Is is commom to have voice symptoms that occur with long periods of talking?  Where your voice feels fatigued and can these symptoms be brought on by a stressfull situation?  
Does EMG need to show abnormality in order to be diagnosed with any type of muscular dystrophy in the early phases?
Hope this wasn't too much, thanks.  dowma.
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ALS Symptoms

Initial or Early Symptoms of ALS
The onset of ALS is often very subtle - these are the initial ALS Symptoms to watch for:

twitching and cramping of the muscles, especially those in the hands and feet

muscle weakness in the arms or legs
loss of motor control in the arms or legs
general weakness and fatigue
tripping and falling
dropping things
slurred or thick speech
difficulty chewing or swallowing
uncontrollable periods of laughing or crying
The parts of the body affected by early symptoms of ALS depend on which muscles in the body are damaged first. For instance, one person may experience trouble grasping or lifting, another person notices that he is stumbling or tripping more often, and a third person may notice episodes of slurred speech.

Muscle weakness is a hallmark initial sign in ALS, occurring in approximately 60% of patients. About 25% have bulbar (throat) onset, which means that voice and swallowing are first affected. About 50% have arm onset, and 25% leg onset.


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