Very worrisome. When ALS begins to destroy nerve cells in the base of the brain, the patient develops loss of ability to swallow and eventually even breathe. This is indeed ominous when it occurs and often leads to early demise.
Bulbar ALS. ALS may affect groups of muscles rather than the entire body. This could be both legs, both arms, or the muscles of the face. Bulbar ALS is a form when the muscles of swallowing, speaking, and facial expression are weak- the so-called bulbar muscles.