The evidence for symptomatic treatments in amyotrophic lateral sclerosis

Thomas M. Jenkins, Hannah Hollinger, Christopher J. Mcdermott

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Purpose of review Amyotrophic lateral sclerosis (ALS) is a progressive, incurable and fatal neurodegenerative disease. Few interventions significantly alter the disease course, but many symptomatic treatments exist to improve patients’ quality of life. In this review, we describe our approach to symptomatic management of ALS and discuss the underlying evidence base.

Recent findings Discussion focuses predominantly on recently published articles. We cover management settings, disease-modifying treatment, vitamin D, respiratory management including noninvasive ventilation and diaphragmatic pacing, secretions, nutrition, dysphagia and gastrostomy, communication problems, mobility, spasticity, pain, cognition, depression and emotional lability, fatigue, sleep disturbance, head drop, prevention of deep venous thrombosis and end-of-life issues.

Summary Multidisciplinary specialist care appears to improve quality of life and survival. Riluzole remains the only available disease-modifying medication and confers a survival advantage of 2–3 months. Noninvasive ventilation improves quality of life and extends survival by approximately 7 months, at least in patients without severe bulbar problems. Nutrition is an independent prognostic factor; whether gastrostomy improves survival and quality of life remains unclear and further studies are underway. Many other symptomatic treatments appear helpful to individuals in clinic, but further randomized clinical trials are required to provide a more robust evidence base.
Original languageEnglish
Pages (from-to)524-531
Number of pages8
JournalCurrent Opinion in Neurology
Volume27
Issue number5
DOIs
Publication statusPublished - 1 Oct 2014

Keywords

  • amyotrophic lateral sclerosis
  • motor neuron disease
  • symptomatic

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