Table 7
Some common symptoms and their treatment in MND
| Symptom | Cause | Treatment |
|---|---|---|
| Treatments that most often prove helpful are underlined; experimental or unproven treatments are indicated by a question mark. | ||
| Cramps | Changes in motor function? | Quinine sulfate 200 mg twice daily |
| Neurone Na+ channel | ||
| Carbamazepine | ||
| Phenytoin | ||
| Magnesium | ||
| Verapamil | ||
| Spasticity | Corticospinal tract damage | Baclofen 10–80 mg daily |
| Tizanidine 6–24 mg daily | ||
| Dantrolene 25–100 mg daily | ||
| Intrathecal baclofen | ||
| Memantine 10–60 mg daily | ||
| Excessive or violent yawning | Corticospinal tract damage? (pseudobulbar syndrome) | Baclofen 10–30 mg daily? |
| Sialorrhoea | Bulbar weakness | Home suction device |
| Atropine 0.25–0.75 mg three times daily (tabs/liquid) | ||
| Atropine eye drops sublingual | ||
| Benztropine (tabs/liquid) | ||
| Benzhexol (tabs) | ||
| Hyoscine (tabs/transdermal patches) | ||
| Amitriptyline oral (tabs/liquid) | ||
| Glycopyrrolate (liquid: sc/im/via PEG) | ||
| Salivary gland irradiation | ||
| Transtympanic neurectomy (?) | ||
| Botox injection to salivary glands (?) | ||
| Tenacious secretions; weak cough | Bulbar and respiratory muscle weakness | Carbocisteine (syrup: 250–750 mg three times daily orally or via gastrostomy) |
| Assisted cough | ||
| Emotional lability | Pseudobulbar syndrome | Amitriptyline |
| SSRIs (e.g. citalopram, fluvoxamine) | ||
| Dextrometorphan plus quinidine (?) | ||
| Anxiety | Many factors | Lorazepam (sublingual, oral: 0.5–4 mg) |
| Diazepam suppositories | ||
| Midazolam (e.g. 2.5 mg stat, 10 mg/24 hours via | ||
| gastrostomy or syringe driver) | ||
| Respiratory distress | Respiratory muscle weakness | Oral morphine (2.5 mg four times daily initially; doses over 100 mg daily may be appropriate) (in addition to or subcutaneous without NIV) |
| Benzodiazepines (sublingual, oral; as suppositories) | ||
| Morphine or diamorphine (subcutaneous infusion) | ||
| Laryngospasm | Pharyngeal sensitivity | Reassurance; avoidance of triggers; sublingual lorazepam? (but spasms usually end within 30–60 seconds) |
| Constipation | Immobility; opiates Dehydration | Hydration; dietary measures; drug management; laxatives |
| Pain | Immobility, stiffness | Comfort (seating, sleeping, night and day care); simple analgesics; NSAIDS; opiates; antidepressants; gabapentin |
| Insomnia | Discomfort, pain, depression; (consider respiratory insufficiency) | Comfort; antidepressants; hypnotics; adequate analgesia |
| Depression | Hopelessness; inability to communicate; frustration | Psychological support and counselling; SSRIs; other antidepressants |
