Palliative care in non-malignant neurological disease

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.