Approach to managing symptoms and complications of motor neurone disease in palliative care

Motor neurone disease affects numerous muscle groups, including those involved in mobility, respiration, swallowing and speech. Use a multidisciplinary approach to ensure ongoing assessment and timely access to interventional options. Regardless of assisted ventilation or nutrition choices, follow the principles of symptom management in palliative care when treating ongoing and progressive symptoms. Significant symptoms and complications in motor neurone disease that are common include:

• anorexia and malnutrition
• cognitive impairment
• insomnia and fatigue
• pain, which is often caused by muscle cramps, spasticity, immobility and shoulder subluxation
• progressive loss of mobility, with physical, emotional, social and existential consequences—see Overview of emotional, psychological and behavioural symptoms in palliative care
• pseudobulbar affect (including yawning, weeping and laughing)
• respiratory failure
• communication and swallowing difficulties, often caused by excessive salivation (sialorrhea).

For advice on provision of equipment and aids and how to make activities of daily living safer and more manageable for patients and carers, refer to an occupational therapist or physiotherapist (if not already available through the managing multidisciplinary clinic).