Abstract
Even in the most severe forms of motor neurone disease--progressive bulbar palsy and amyotrophic lateral sclerosis--the symptoms and disabilities from progressive paralysis may be relieved in many patients by various symptomatic treatments. Quality of life may be improved even in the terminal stage, when narcotic administration should be considered. The physician's proper role is to offer and carefully supervise these treatments, not withhold them. Home care is recommended even for the most severely paralysed, though hospice care may be a good alternative. The underlying principle--to alleviate symptoms--applies to the management of all progressive incurable diseases.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bernstein D. S., Sadowsky N., Hegsted D. M., Guri C. D., Stare F. J. Prevalence of osteoporosis in high- and low-fluoride areas in North Dakota. JAMA. 1966 Oct 31;198(5):499–504. [PubMed] [Google Scholar]
- Bikle D. D. Fluoride treatment of osteoporosis: a new look at an old drug. Ann Intern Med. 1983 Jun;98(6):1013–1015. doi: 10.7326/0003-4819-98-6-1013. [DOI] [PubMed] [Google Scholar]
- Denys E. H., Norris F. H., Jr Amyotrophic lateral sclerosis. Impairment of neuromuscular transmission. Arch Neurol. 1979 Apr;36(4):202–205. doi: 10.1001/archneur.1979.00500400056008. [DOI] [PubMed] [Google Scholar]
- Fallat R. J., Jewitt B., Bass M., Kamm B., Norris F. H., Jr Spirometry in amyotrophic lateral sclerosis. Arch Neurol. 1979 Feb;36(2):74–80. doi: 10.1001/archneur.1979.00500380044004. [DOI] [PubMed] [Google Scholar]
- Gauderer M. W., Ponsky J. L., Izant R. J., Jr Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg. 1980 Dec;15(6):872–875. doi: 10.1016/s0022-3468(80)80296-x. [DOI] [PubMed] [Google Scholar]
- Janiszewski D. W., Caroscio J. T., Wisham L. H. Amyotrophic lateral sclerosis: a comprehensive rehabilitation approach. Arch Phys Med Rehabil. 1983 Jul;64(7):304–307. [PubMed] [Google Scholar]
- LENMAN J. A. A clinical and experimental study of the effects of exercise on motor weakness in neurological disease. J Neurol Neurosurg Psychiatry. 1959 Aug;22:182–194. doi: 10.1136/jnnp.22.3.182. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lebo C. P., U K. S., Norris F. H., Jr Cricopharyngeal myotomy in amyotrophic lateral sclerosis. Laryngoscope. 1976 Jun;86(6):862–868. doi: 10.1288/00005537-197606000-00013. [DOI] [PubMed] [Google Scholar]
- Levinsky N. G. The doctor's master. N Engl J Med. 1984 Dec 13;311(24):1573–1575. doi: 10.1056/NEJM198412133112412. [DOI] [PubMed] [Google Scholar]
- MULDER D. W., LAMBERT E. H., EATON L. M. Myasthenic syndrome in patients with amyotrophic lateral sclerosis. Neurology. 1959 Oct;9:627–631. doi: 10.1212/wnl.9.10.627. [DOI] [PubMed] [Google Scholar]
- Mills C. P. Dysphagia in pharyngeal paralysis treated by cricopharyngeal sphincterotomy. Lancet. 1973 Mar 3;1(7801):455–457. doi: 10.1016/s0140-6736(73)91881-3. [DOI] [PubMed] [Google Scholar]
- Newrick P. G., Langton-Hewer R. Motor neurone disease: can we do better? A study of 42 patients. Br Med J (Clin Res Ed) 1984 Sep 1;289(6444):539–542. doi: 10.1136/bmj.289.6444.539. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Norris F. H., Jr, Sang U. K., Denys E. H., Archibald K. C., Lebo C. Amyotrophic lateral sclerosis. Mayo Clin Proc. 1978 Aug;53(8):544–544. [PubMed] [Google Scholar]
- Perry A. R., Gawel M., Rose F. C. Communication aids in patients with motor neurone disease. Br Med J (Clin Res Ed) 1981 May 23;282(6277):1690–1692. doi: 10.1136/bmj.282.6277.1690. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Russell T. R., Brotman M., Norris F. Percutaneous gastrostomy. A new simplified and cost-effective technique. Am J Surg. 1984 Jul;148(1):132–137. doi: 10.1016/0002-9610(84)90300-3. [DOI] [PubMed] [Google Scholar]
- Sivak E. D., Cordasco E. M., Gipson W. T. Pulmonary mechanical ventilation at home: a reasonable and less expensive alternative. Respir Care. 1983 Jan;28(1):42–49. [PubMed] [Google Scholar]
- Sivak E. D., Gipson W. T., Hanson M. R. Long-term management of respiratory failure in amyotrophic lateral sclerosis. Ann Neurol. 1982 Jul;12(1):18–23. doi: 10.1002/ana.410120104. [DOI] [PubMed] [Google Scholar]
- Smith R. A., Norris F. H., Jr Symptomatic care of patients with amyotrophic lateral sclerosis. JAMA. 1975 Nov 17;234(7):715–717. [PubMed] [Google Scholar]
- Udaka F., Yamao S., Nagata H., Nakamura S., Kameyama M. Pathologic laughing and crying treated with levodopa. Arch Neurol. 1984 Oct;41(10):1095–1096. doi: 10.1001/archneur.1984.04050210093023. [DOI] [PubMed] [Google Scholar]