title: Neurologic aspects of palliative care: the end of life setting.
abstract: As there are, to date, few curative treatment options for many neurologic diseases, end of life (EOL) care is an important aspect of the treatment of neurologic patients. In the EOL phase, treatment should be aimed at relieving symptoms, maintaining quality of life, and facilitating a peaceful and dignified way of dying. Common signs and symptoms in the EOL phase of neurologic patients are raised intracranial pressure, seizures, confusion, cognitive deficits, and impaired motor function. Supportive treatment of these symptoms (such as analgesic drugs, dexamethasone, antiepileptic and neuroleptic drugs) is of major importance to maintain quality of life as long as possible. Another key aspect of EOL care is EOL decision making, such as withholding or withdrawing life-sustaining treatment, and palliative sedation. The main goal of EOL decision making is the prevention and relief of suffering, even if this might hasten death. Especially in advanced stages of many neurologic diseases, confusion, cognitive deficits, communication deficits, and decreasing levels of consciousness may impair the competence of patients to participate in EOL decision making. Given that patient autonomy is increasingly essential, advance care planning (ACP) at an early stage of the disease should be considered.
authors.affiliation: Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: e.sizoo@vumc.nl.
authors.forename: Eefje M
authors.initials: EM
authors.lastname: Sizoo
authors.affiliation: Department of Neurology, Kaiser Franz Josep Hospital, Vienna, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Grisold
authors.affiliation: Department of Neurology, Medical Center Haaglanden, The Hague, Netherlands.
authors.forename: Martin J B
authors.initials: MJ
authors.lastname: Taphoorn
mesh_terms: D032722:Advance Care Planning; D006117:Grief; D006801:Humans; D009069:Movement Disorders / Q000503:physiopathology / Q000628:therapy; D009422:Nervous System Diseases / Q000503:physiopathology* / Q000628:therapy*; D010166:Palliative Care; D016414:Resuscitation Orders; D013727:Terminal Care / Q000523:psychology
keywords: Palliative care; advanced care planning; bereavement; end of life; euthanasia