Table 7

Some common symptoms and their treatment in MND

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
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 weaknessCarbocisteine (syrup: 250–750 mg three times daily orally or via gastrostomy)
Assisted cough
Emotional lability Pseudobulbar syndromeAmitriptyline
SSRIs (e.g. citalopram, fluvoxamine)
Dextrometorphan plus quinidine (?)
Anxiety Many factorsLorazepam (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 weaknessOral 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 sensitivityReassurance; avoidance of triggers; sublingual lorazepam? (but spasms usually end within 30–60 seconds)
Constipation Immobility; opiates DehydrationHydration; dietary measures; drug management; laxatives
Pain Immobility, stiffnessComfort (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; frustrationPsychological support and counselling; SSRIs; other antidepressants