title: EFNS guidelines on the clinical management of amyotrophic lateral sclerosis (MALS)--revised report of an EFNS task force.
abstract: BACKGROUND
  The evidence base for the diagnosis and management of amyotrophic lateral sclerosis (ALS) is weak.
  
  
  OBJECTIVE
  To provide evidence-based or expert recommendations for the diagnosis and management of ALS based on a literature search and the consensus of an expert panel.
  
  
  METHODS
  All available medical reference systems were searched, and original papers, meta-analyses, review papers, book chapters and guidelines recommendations were reviewed. The final literature search was performed in February 2011. Recommendations were reached by consensus.
  
  
  CONCLUSIONS
  Patients with symptoms suggestive of ALS should be assessed as soon as possible by an experienced neurologist. Early diagnosis should be pursued, and investigations, including neurophysiology, performed with a high priority. The patient should be informed of the diagnosis by a consultant with a good knowledge of the patient and the disease. Following diagnosis, the patient and relatives/carers should receive regular support from a multidisciplinary care team. Medication with riluzole should be initiated as early as possible. Control of symptoms such as sialorrhoea, thick mucus, emotional lability, cramps, spasticity and pain should be attempted. Percutaneous endoscopic gastrostomy feeding improves nutrition and quality of life, and gastrostomy tubes should be placed before respiratory insufficiency develops. Non-invasive positive-pressure ventilation also improves survival and quality of life. Maintaining the patient's ability to communicate is essential. During the entire course of the disease, every effort should be made to maintain patient autonomy. Advance directives for palliative end-of-life care should be discussed early with the patient and carers, respecting the patient's social and cultural background.
authors.affiliation: Umeå University, Umeå, Sweden. Peter.Andersen@neuro.umu.se
authors.forename: Peter M
authors.initials: PM
authors.lastname: Andersen
authors.forename: Sharon
authors.initials: S
authors.lastname: Abrahams
authors.forename: Gian D
authors.initials: GD
authors.lastname: Borasio
authors.forename: Mamede
authors.initials: M
authors.lastname: de Carvalho
authors.forename: Adriano
authors.initials: A
authors.lastname: Chio
authors.forename: Philip
authors.initials: P
authors.lastname: Van Damme
authors.forename: Orla
authors.initials: O
authors.lastname: Hardiman
authors.forename: Katja
authors.initials: K
authors.lastname: Kollewe
authors.forename: Karen E
authors.initials: KE
authors.lastname: Morrison
authors.forename: Susanne
authors.initials: S
authors.lastname: Petri
authors.forename: Pierre-Francois
authors.initials: PF
authors.lastname: Pradat
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Silani
authors.forename: Barbara
authors.initials: B
authors.lastname: Tomik
authors.forename: Maria
authors.initials: M
authors.lastname: Wasner
authors.forename: Markus
authors.initials: M
authors.lastname: Weber
mesh_terms: D026683:Advisory Committees; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis* / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans