EFNS guidelines on the Clinical Management of Amyotrophic Lateral Sclerosis (MALS) - revised report of an EFNS task force

Peter M. Andersen, Sharon Abrahams, Gian D. Borasio, Mamede de Carvalho, Adriano Chio, Philip Van Damme, Orla Hardiman, Katja Kollewe, Karen E. Morrison, Susanne Petri, Pierre Francois Pradat, Vincenzo Silani, Barbara Tomik, Maria Wasner, Markus Weber

Research output: Contribution to journalArticle

Abstract

Background: The evidence base for the diagnosis and management of amyotrophic lateral sclerosis (ALS) is weak. Objectives: To provide evidence-based or expert recommendations for the diagnosis and management of ALS based on a literature search and the consensus of an expert panel. Methods: All available medical reference systems were searched, and original papers, meta-analyses, review papers, book chapters and guidelines recommendations were reviewed. The final literature search was performed in February 2011. Recommendations were reached by consensus. Recommendations: Patients with symptoms suggestive of ALS should be assessed as soon as possible by an experienced neurologist. Early diagnosis should be pursued, and investigations, including neurophysiology, performed with a high priority. The patient should be informed of the diagnosis by a consultant with a good knowledge of the patient and the disease. Following diagnosis, the patient and relatives/carers should receive regular support from a multidisciplinary care team. Medication with riluzole should be initiated as early as possible. Control of symptoms such as sialorrhoea, thick mucus, emotional lability, cramps, spasticity and pain should be attempted. Percutaneous endoscopic gastrostomy feeding improves nutrition and quality of life, and gastrostomy tubes should be placed before respiratory insufficiency develops. Non-invasive positive-pressure ventilation also improves survival and quality of life. Maintaining the patient's ability to communicate is essential. During the entire course of the disease, every effort should be made to maintain patient autonomy. Advance directives for palliative end-of-life care should be discussed early with the patient and carers, respecting the patient's social and cultural background.

Original languageEnglish
Pages (from-to)360-375
Number of pages16
JournalEuropean Journal of Neurology
Volume19
Issue number3
DOIs
Publication statusPublished - Mar 2012

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Keywords

  • ALS
  • Breaking the diagnosis
  • Bronchial secretions
  • Caregiver
  • Cognitive dysfunction
  • Drooling
  • Evidence-based medicine
  • Genetic counselling
  • Nutrition
  • Palliative care
  • Terminal care
  • Ventilation

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Andersen, P. M., Abrahams, S., Borasio, G. D., de Carvalho, M., Chio, A., Van Damme, P., Hardiman, O., Kollewe, K., Morrison, K. E., Petri, S., Pradat, P. F., Silani, V., Tomik, B., Wasner, M., & Weber, M. (2012). EFNS guidelines on the Clinical Management of Amyotrophic Lateral Sclerosis (MALS) - revised report of an EFNS task force. European Journal of Neurology, 19(3), 360-375. https://doi.org/10.1111/j.1468-1331.2011.03501.x