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Review
. 2015 Nov;33(4):889-908.
doi: 10.1016/j.ncl.2015.07.010.

Symptom Management and End-of-Life Care in Amyotrophic Lateral Sclerosis

Carlayne E Jackson  1 , April L McVey  2 , Stacy Rudnicki  3 , Mazen M Dimachkie  4 , Richard J Barohn  2
Affiliations
Review

Symptom Management and End-of-Life Care in Amyotrophic Lateral Sclerosis

Carlayne E Jackson et al. Neurol Clin. 2015 Nov.

Abstract

The number of available symptomatic treatments has markedly enhanced the care of patients with amyotrophic lateral sclerosis (ALS). Once thought to be untreatable, patients with ALS today clearly benefit from multidisciplinary care. The impact of such care on the disease course, including rate of progression and mortality, has surpassed the treatment effects commonly sought in clinical drug trials. Unfortunately, there are few randomized controlled trials of medications or interventions addressing symptom management. In this review, the authors provide the level of evidence, when available, for each intervention that is currently considered standard of care by consensus opinion.

Keywords: Constipation; Edema; Laryngospasm; Noninvasive ventilation; Pseudobulbar affect; Secretion management; Sialorrhea; Urinary urgency.

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Figures

Figure 1
Figure 1. Respiratory management algorithm
PFT = pulmonary function tests; PCEF = peak cough expiratory flow; NIV = noninvasive ventilation; SNP = sniff nasal pressure; MIP = maximal inspiratory pressure; FVC = forced vital capacity (supine or erect); Abnl.nocturnal oximetry = pO2 <4% from baseline. *Symptoms suggestive of nocturnal hypoventilation: frequent arousals, morning headaches, excessive daytime sleepiness, vivid dreams, †If NIV is not tolerated or accepted in the setting of advancing respiratory compromise, consider invasive ventilation or referral to hospice. Taken from 23 Miller
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References

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