Supportive and symptomatic management of amyotrophic lateral sclerosis

  title={Supportive and symptomatic management of amyotrophic lateral sclerosis},
  author={Esther V Hobson and Christopher J Mcdermott},
  journal={Nature Reviews Neurology},
The main aims in the care of individuals with amyotrophic lateral sclerosis (ALS) are to minimize morbidity and maximize quality of life. Although no cure exists for ALS, supportive and symptomatic care provided by a specialist multidisciplinary team can improve survival. The basis for supportive management is shifting from expert consensus guidelines towards an evidence-based approach, which encourages the use of effective treatments and could reduce the risk of harm caused by ineffective or… 

Symptom management in amyotrophic lateral sclerosis: We can do better

The study presented by Nicholson and colleagues in this issue provides insight into the current state of symptom management of a cohort of ALS patients and calls attention to the relatively high prevalence of anxiety and depression, consistent with the overall significant psychological morbidity noted in patients with ALS.

Multidisciplinary care in Amyotrophic Lateral Sclerosis: a systematic review and meta-analysis

Multidisciplinary care is more effective than general neurology care at improving survival of patients with ALS, but only improves mental health outcomes related to quality of life of these patients.

Amyotrophic Lateral Sclerosis: Integrated care provides the best quality of life.

The standard of care for patients with ALS/MND is reviewed and the experience in implementing a multidisciplinary ALS center is shared.

Polish Association for Palliative Medicine stand on qualification for palliative care and management of patients with amyotrophic lateral sclerosis and multiple sclerosis

The burden of care in the advanced stage of the disease should be transferred from functional improvement of the patient to limitation of suffering and providing the patient with comfort.

Gastrostomy and mechanical ventilation in amyotrophic lateral sclerosis: how best to support the decision-making process?

An overview of the life-sustaining methods used in ALS and their effects on disease progression, survival and quality of life of patients and their caregivers is presented.

A perspective on therapies for amyotrophic lateral sclerosis: can disease progression be curbed?

Current and prospective therapies for ALS are summarized and stem cell therapies, gene therapies, and newly-developed biomaterials have great potentials in alleviating neurodegeneration, which might halt the disease progression.

Reflections on the implementation of the provisional best practices guidelines for the evaluation of bulbar dysfunction in ALS

The Provisional Best Practices Guidelines for the Evaluation of Bulbar Dysfunction in ALS by Pattee et al, published in this edition of Muscle & Nerve, represents a landmark accomplishment in the field and the authors are congratulated on this work.

Diagnostics of Amyotrophic Lateral Sclerosis: Up to Date

The typical form of ALS with upper and lower motoneuron involvement and progressive bulbar paralysis with bulbar muscle involvement is observed and survival may be prolonged based on prompt diagnosis, ALS subtype and proper management with supportive treatment.



Is tracheostomy still an option in amyotrophic lateral sclerosis? Reflections of a multidisciplinary work group.

Current practice in Switzerland and France tends to discourage the use of TPPV in ALS, and improved management of secretions and use of different interfaces allows NIV to be used 24-hours-a-day for prolonged periods, thus avoidingTPPV in many cases.

Practice Parameter update: The care of the patient with amyotrophic lateral sclerosis: Multidisciplinary care, symptom management, and cognitive/behavioral impairment (an evidence-based review)

Objective: To systematically review evidence bearing on the management of patients with amyotrophic lateral sclerosis (ALS). Methods: The authors analyzed studies from 1998 to 2007 to update the 1999

Is There a Role for Exercise in the Management of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis?

  • E. Plowman
  • Medicine, Psychology
    Journal of speech, language, and hearing research : JSLHR
  • 2015
Insufficient data exist to support or refute the role of exercise in the management of bulbar dysfunction in PALS, and this represents a critical area of future investigation.

Riluzole for amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND).

Riluzole 100 mg per day appears to be modestly effective in prolonging survival for patients with ALS.

Depression and Anxiety in Individuals with Amyotrophic Lateral Sclerosis

Evidence from other patient groups, such as elderly patients diagnosed with major depressive disorder, suggests that a combination of both therapies has the potential to also improve depression and anxiety in patients with ALS.

Identifying who will benefit from non-invasive ventilation in amyotrophic lateral sclerosis/motor neurone disease in a clinical cohort

Data confirm that NIV improves survival in MND/ALS and the overall magnitude of benefit is 13 months and was largest in those with ALS-bulbar disease.

A multidisciplinary clinic approach improves survival in ALS: a comparative study of ALS in Ireland and Northern Ireland

It is proposed that multiple decision-making processes within a multidisciplinary setting lead to an enriched set of clinical encounters for the patient and carer that enhances clinical outcome.

Early treatment with noninvasive positive pressure ventilation prolongs survival in Amyotrophic Lateral Sclerosis patients with nocturnal respiratory insufficiency

Investigating 1 year survival of ALS patients with FVC < 75% and nocturnal respiratory insufficiency, treated with NPPV, compared to a well-matched population ofALS patients, demonstrates that early treatment with N PPV prolongs survival and reduces decline of FVC% in ALS.

Drug therapy for pain in amyotrophic lateral sclerosis or motor neuron disease.

No randomised or quasi-randomised controlled trials on drug therapy for pain in ALS or MND were found and further research on this important aspect of palliative care in ALS is needed.