What are the current guidelines for the management of symptoms in pati

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Management of symptoms in patients with motor neurone disease (MND) includes both pharmacological and non-pharmacological approaches.

Pharmacological treatments: Riluzole is recommended as a disease-modifying treatment for the amyotrophic lateral sclerosis form of MND .
For muscle problems such as weakness, stiffness, and cramps, treatment options should be discussed, including medications and supportive therapies .
To manage sialorrhoea (excess saliva), glycopyrronium bromide can be considered as a first-line treatment, especially in those with cognitive impairment, due to fewer CNS side effects, although this is off-label .
Referral to specialist services for botulinum toxin A (e.g., Xeomin) is recommended for treating chronic sialorrhoea caused by neurological conditions in adults .
Symptom management also involves addressing respiratory issues, with considerations for non-invasive ventilation and respiratory support .
Other symptoms such as pain, constipation, and psychological needs should be regularly assessed and managed appropriately, with multidisciplinary team involvement .
Non-pharmacological approaches include: provision of equipment and adaptations to aid activities of daily living and mobility, such as assistive technology, wheelchairs, and environmental modifications, to maintain participation and quality of life .
Support for communication and end-of-life planning should be tailored to individual needs, including advance care planning and access to specialist palliative care when appropriate .

What are the current guidelines for the management of symptoms in patients with MND, including pharmacological and non-pharmacological approaches?