Chapter 10 - Palliative treatment of chronic neurologic disorders
Introduction
Whereas a palliative care approach is commonly accepted for neurologic patients with a glioblastoma or brain metastases, a palliative approach to management currently is not followed in many other neurologic disorders. Yet, decades ago, in her visionary concept of palliative care, Cicely Saunders included patients with amyotrophic lateral sclerosis (ALS) and other motor neurone diseases (MND). We embrace her “total symptom” multiprofessional approach, in which early palliative care is integrated into the care of patients suffering from chronic neurologic disorders.
Section snippets
Parkinson's disease and related conditions
Parkinson’s disease (PD) and Parkinson-related conditions, such as progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal degeneration (CBD), are more common than ALS and usually have a longer course of disease. No disease-modifying or effective neuroprotective agents are currently effective for any of these diseases. Disease trajectory is frequently divided into the supportive phase, the phase of transition, and the terminal phase (Bunting-Perry, 2006).
Patients
Dementia
Because of the worldwide increase in life expectancy, an increase in dying persons with dementia is expected. The number of patients suffering from dementia currently is estimated at 35.6 million. Presumably, this number will double by 2030 and triple by 2050 (World Health Organization, 2012). Therefore, an increasing number of people die with dementia. A population-based study conducted in Britain found that 6% of individuals aged 65–69 and 60% of those aged 95 suffered from dementia at the
Multiple sclerosis
Multiple sclerosis (MS) is a chronic, relapsing, progressive inflammatory autoimmune disorder of the brain, spinal cord, and optic nerves that affects 2.5 million people worldwide and in some countries constitutes the most common cause of neurologic disability among young adults. In recent years, a number of immunomodulatory therapies have been developed that can modify disease activity (Miller and Rhoades, 2012). However, the effect of these therapies on the natural history of the disease
Amyotrophic lateral sclerosis
The diagnosis of ALS is a devastating event for the patient and family. The lack of curative therapeutic options, the limited benefit of existing life-prolonging treatments, and the often rapid progression make a palliative approach to treatment indispensable. The multitude of symptoms producing suffering and the usually unforeseeable onset of symptoms require a flexible and efficient multiprofessional care plan. For neurologists, the main task after confirming the diagnosis is to identify and
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