Symptom | Frequency | Management |
Hypersalivation and drooling | Mostly patients with bulbar onset (approx 30%) | Thin secretions: Hyoscine patches, amitriptyline, glycopyrronium, botulinum toxin. Thick secretions: pineapple or papaya juice, nebulised saline, β blockers |
Spasticity, cramps and fasciculation | Often a transient feature which recedes with disease progression. Not necessary to treat in most. | Exercise and physiotherapy, baclofen or tizanidine, gabapentin, botulinum toxin, especially once the patient can no longer walk |
Nocturnal sleep fragmentation and daytime somnolence | Symptomatic in about 40-50% of ALS patients | Nasal intermittent positive pressure ventilation by mask |
Dyspnoea at the end of life | A minority | Oramorph, with consent of patient, acknowledging secondary respiratory compromise effects of drug treatment |
Emotionality | Approximately 10% of patients, often a transient feature | Amitriptyline, selective serotonin reuptake inhibitors |
Nutritional insufficiency | Inevitable but affects people at different stages | About 60-70% of patients require enteral feeding (PEG or RIG) |
Neck weakness, head drop | 10-20% | Specialist collars such as the “Headmaster” |
ALS, amyotrophic lateral sclerosis; PEG, percutaneous endoscopic gastrostomy; RIG, radiologically inserted gastrostomy.