Klinische Leitlinien zur Behandlung der Amyotrophen Lateralsklerose

The evidence base for diagnosis and management of Amyotrophic Lateral Sclerosis (ALS) is still weak, and curative therapy is lacking. Nonetheless, early diagnosis and symptomatic and therapy can profoundly influence care and quality of life of the patient and relatives, and may increase survival time. This review addresses the current optimol clinical approach to ALS. The literature search is complete to December 2006. Where there was lack of evidence but consensus was clear we have stated our opinion as good practice points. We conclude that a diagnosis of ALS can be achieved by early examination by an experienced neurologist. The patient should be informed of the diagnosis by the consultant. Following diagnosis, a multi-diciplinary care team should support the patient and relatives. Medication with riluzole should be initiated as early as possible. Percutaneous endocopic gastrostomy (PEG) is associated with improved nutrition and should be inserted early. Non-invasive positive pressure ventilation improves survival and quality of life but is underused in Europe. Maintaining the patient's ability to communicate is essential. During the course of the disease, every effort should be made to maintain patient autonomy. Advance directives for palliative end of life care are important and should be discussed early with the patient and relatives if they so wish.