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Practice parameter: The care of the patient with amyotrophic lateral sclerosis (an evidence-based review)

Report of the Quality Standards Subcommittee of the American Academy of Neurology

R. G. Miller, MD, J. A. Rosenberg, MD, D. F. Gelinas, MD, H. Mitsumoto, MD, D. Newman, MD, R. Sufit, MD, G. D. Borasio, MD, W. G. Bradley, DM, FRCP, M. B. Bromberg, MD, PhD, B. R. Brooks, MD, E. J. Kasarskis, MD, PhD, T. L. Munsat, MD, E. A. Oppenheimer, MD and the ALS Practice Parameters Task Force*

From the American Academy of Neurology, St. Paul, MN.



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  		Figure 1. Algorithm for sialorrhea management.

 


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  		Figure 2. Algorithm for nutrition management. 1Rule out contraindications. 2Prolonged mealtime, ending meal prematurely because of fatigue, accelerated weight loss due to poor caloric intake, family concern about feeding difficulties. *Forced vital capacity (FVC) or vital capacity (VC) can be used. VC may be more accurate in patients with bulbar dysfunction. 3For example, Colorado Dysphagia Disability Inventory, bulbar questions in the ALS Functional Rating Scale, or other instrument. Dx = diagnosis; PEG = percutaneous endoscopic gastrostomy.

 


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  		Figure 3. Algorithm for respiratory management. 1Forced vital capacity (FVC) or vital capacity (VC) can be used. VC may be more accurate in patients with bulbar dysfunction. 2Agreement needed for conditions of withdrawal prior to or concurrent with instituting invasive ventilation (e.g., locked in state, coma, etc.). Dx = diagnosis.

 




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