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

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 ¹.
• For muscle problems such as weakness, stiffness, and cramps, treatment options should be discussed, including medications and supportive therapies ¹.
• 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 ¹.
• Referral to specialist services for botulinum toxin A (e.g., Xeomin) is recommended for treating chronic sialorrhoea caused by neurological conditions in adults ¹.
• Symptom management also involves addressing respiratory issues, with considerations for non-invasive ventilation and respiratory support ¹.
• Other symptoms such as pain, constipation, and psychological needs should be regularly assessed and managed appropriately, with multidisciplinary team involvement ¹.
• 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 ¹.
• 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 ¹.