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©2013 UpToDate ® Print Email Axial signs and symptoms associated with amyotrophic lateral sclerosis Upper motor neuron signs Absent abdominal reflexes Lower motor neuron signs Neck extension weakness Truncal extension weakness; bent spine Abdominal protuberance Increased lumbar lordosis Upper motor neuron symptoms Stiffness and imbalance Lower motor neuron symptoms Neck extensors Difficulty holding up the head When severe produces head drop Truncal extensors Difficulty maintaining an erect posture Lumbar extensors Increased lumbar lordosis Abdominal wall muscles Abdominal protuberance Cramps