title: The evidence for symptomatic treatments in amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Sheffield Institute for Translational Neuroscience, Sheffield, UK.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Jenkins
authors.forename: Hannah
authors.initials: H
authors.lastname: Hollinger
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: McDermott
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D019468:Disease Management; D006801:Humans; D011788:Quality of Life