A survey of clinicians' practice in the symptomatic treatment of ALS.
Symptomatic management is the mainstay of ALS patient care, but there are few controlled trials of drugs and interventions for common symptoms.


METHODS
We queried ALS clinic neurologists to determine drugs and interventions of choice and neurologists' perceived efficacy for 14 symptoms.


RESULTS
The results are tabulations of the physicians' four most frequent choices for each symptom, the physicians' perception of efficacy, the average doses and average daily costs. A wide range of drugs and interventions were nominated for management of ALS symptoms. Consensus on treatment was rare for individual symptoms, and efficacy for any symptom was judged moderate at best. A few drugs were recommended for multiple symptoms. Comparisons of perceived efficacy compared to drug costs are informative.


CONCLUSIONS
The results of the survey emphasize the challenges of symptom management in ALS. These data aid clinical management and guide rational choices for randomized controlled trials.
Forshew
Dallas A
DA
Department of Neurology, University of California San Francisco, San Francisco, CA 94117, USA. forshew@itsa.ucsf.edu
Bromberg
Mark B
MB
D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D003248:Constipation; D003863:Depression; D019468:Disease Management; D004644:Emotions; D019317:Evidence-Based Medicine; D005207:Fasciculation; D005221:Fatigue; D019538:Health Care Surveys; D006801:Humans; D007826:Laryngismus; D009120:Muscle Cramp; D009128:Muscle Spasticity; D012189:Retrospective Studies; D012798:Sialorrhea; D012893:Sleep Wake Disorders; D011795:Surveys and Questionnaires; D014555:Urination Disorders