Management strategies for patients with amyotrophic lateral sclerosis from diagnosis through death.
BACKGROUND
Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disorder that is inevitably fatal. There are no effective treatments to stop or reverse the natural course of the disease. The role of the physician is to provide comfort and optimize quality of life.


RESULTS
Management of patients with ALS is a process extending over months to years. It begins with breaking the news of the diagnosis and extends through the terminal phase. Medication may extend lifespan by a small amount. However, most efforts are centered around symptom management. Areas of importance include respiration, nutrition, secretions, communication, pseudobulbar affect, therapy and exercise, spasticity and cramps, pain, depression and suicide, spirituality and religion, cognitive changes, the development of advance directives, and care at the end of life. Multidisciplinary ALS clinics provide much-needed support for patients with ALS and their caregivers.


CONCLUSIONS
Although physicians cannot cure ALS or even halt progression, there is much that can be done to manage the physical and emotional symptoms, thereby maintaining or enhancing quality of life.
Simmons
Zachary
Z
Department of Neurology, Penn State College of Medicine, Hershey, 17033, USA. zsimmons@psu.edu
D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D006738:Hospices; D006801:Humans; D018696:Neuroprotective Agents / Q000627:therapeutic use; D009747:Nutritional Physiological Phenomena; D010146:Pain / Q000209:etiology; D011788:Quality of Life; D019782:Riluzole / Q000627:therapeutic use; D029181:Spirituality; D013405:Suicide
D018696:Neuroprotective Agents; D019782:Riluzole