Treatment
There is no curative treatment for motor neurone disease. Care is provided by a multidisciplinary team of healthcare professionals including neurologists, specialist nurses, physiotherapists, speech therapists, occupational therapists, community nurses, social workers and general practitioners.
Riluzole, a drug given orally may have some effect in slowing the progression of the disease although the evidence is weak and remains controversial.
Other drugs are prescribed to relieve symptoms; these include:
- Baclofen, dantrolene, diazepam, gabapentin to relieve muscle stiffness and cramps
- Analgesics – paracetamol, non-steroidal antiflammatories (NSAIDs) e.g.ibuprofen to relieve pain and joint stiffness
- Hyoscine, atropine to reduce salivation
- Antidepressants e.g. amitriptiline, fluoxetine to alleviate symptoms of anxiety, depression and emotional lability
- Benzodiazepines e.g. diazepam to reduce anxiety
- Opiates e.g. morphine, fentanyl, oxycodone to control pain, treat breathlessness, choking attacks and reduce anxiety
Speech therapists advise on other means of communication as the ability to speak fails. Computer assisted devices may be used.
When the person develops difficulty in swallowing a tube may be placed in the gut to facilitate feeding and fluid intake. A tube can be passed in to the gastrointestinal tract via the nose and throat (naso-gastric tube), or it can be inserted directly into the stomach via the anterior abdominal wall (percutaneous endoscopic gastrostomy – PEG). Fluids and nutrients in a liquid form are run into the stomach by these methods. These methods of feeding may be used in combination with oral eating and drinking, while swallowing ability remains.
As breathing becomes increasingly difficult some people may have assisted ventilation via a machine that blows air under pressure into the lungs through a mask (non-invasive ventilation). In a minority of cases a tracheostomy may be created and the person receives full artificial mechanical respiration.
As the disease advances the multidisciplinary team provides palliative care and is joined by specialist palliative care nurses and hospice doctors. Terminal care may take place in the home or be based in a hospice setting.
Amended June 2008
