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Multiple sclerosis Multiple sclerosis
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Symptom management Symptom management
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Immobility Immobility
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Pain Pain
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Spasticity Spasticity
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Management Management
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Ataxia and tremor Ataxia and tremor
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Urinary system Urinary system
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Constipation Constipation
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Fatigue Fatigue
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Mood/cognitive disturbance Mood/cognitive disturbance
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References References
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Further reading Further reading
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References References
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Further reading Further reading
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Parkinson’s disease Parkinson’s disease
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Criteria for the diagnosis of Parkinson’s disease Criteria for the diagnosis of Parkinson’s disease
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Management Management
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Motor symptoms Motor symptoms
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Levodopa preparations Levodopa preparations
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Dopamine agonists Dopamine agonists
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Drugs that delay the breakdown of levodopa Drugs that delay the breakdown of levodopa
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Anticholinergics Anticholinergics
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Glutamate inhibitors (e.g. amantadine) Glutamate inhibitors (e.g. amantadine)
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Monoamine oxidase type B selective inhibitor (selegiline, rasagiline) Monoamine oxidase type B selective inhibitor (selegiline, rasagiline)
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Nausea and vomiting Nausea and vomiting
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Depression Depression
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Constipation Constipation
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Swallowing difficulties Swallowing difficulties
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Postural hypotension Postural hypotension
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Sleep Sleep
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Communication Communication
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Dementia Dementia
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Confusion/hallucinations Confusion/hallucinations
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Pain Pain
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Anxiety Anxiety
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The terminal phase The terminal phase
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Further reading Further reading
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Further reading Further reading
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Multiple system atrophy Multiple system atrophy
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Progressive supranuclear palsy Progressive supranuclear palsy
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Motor neurone disease Motor neurone disease
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Management Management
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Symptoms Symptoms
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Weakness Weakness
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Insomnia Insomnia
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Respiratory insufficiency Respiratory insufficiency
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Pseudobulbar affect Pseudobulbar affect
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Pain Pain
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Management of the cause of pain Management of the cause of pain
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The use of opioids in MND The use of opioids in MND
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Dysphagia Dysphagia
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Dysarthria Dysarthria
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Breathlessness Breathlessness
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Choking Choking
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The multidisciplinary team The multidisciplinary team
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Further reading Further reading
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Further reading Further reading
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Creutzfeldt–Jakob disease Creutzfeldt–Jakob disease
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Further reading Further reading
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Useful contacts Useful contacts
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MS-UK MS-UK
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Multiple Sclerosis Society Multiple Sclerosis Society
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Motor Neurone Disease Association Motor Neurone Disease Association
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The National CJD Surveillance Unit The National CJD Surveillance Unit
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NHS National Prion Clinic NHS National Prion Clinic
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21 Palliative care in non-malignant neurological disease
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Published:July 2019
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Abstract
This chapter covers the palliative care aspects of non-malignant neurological diseases, including multiple sclerosis, Parkinson’s disease, motor neurone disease, multiple system atrophy, progressive supranuclear palsy, and Creutzfeldt–Jakob disease. MS is a disease characterized by inflammation and demyelination affecting the central nervous system and ultimately injury and gliosis. Parkinson’s disease (PD) is the commonest neurodegenerative disease after Alzheimer’s disease, with an estimated incidence of 2/1000. It affects just under 1% of people over the age of 65 years. PD is probably not one disease but several with common clinical features. Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized by Parkinsonian features, plus autonomic dysfunction in the form of orthostatic hypotension, and/or urogenital dysfunction in the form of incontinence and incomplete bladder emptying. At times it can also include cerebellar symptoms. It is not hereditary, and affects adults usually in the fourth or fifth decade. Post-mortem studies of patients diagnosed with PD indicate that 10–25% had multiple system atrophy.
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