Palliative Neurology

, by Ian Maddocks , Bruce Brew , Heather Waddy , Ian Williams

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ISBN: 9780521672498 | 052167249X
Cover: Paperback
Copyright: 12/19/2005

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Palliative care affirms the value of holistic support for persons facing death from advanced disease. This handbook aims to provide succinct and practical advice on the management of major neurological disorders in both their supportive and terminal phases, recognizing that these conditions are increasing in prevalence in virtually every society as the proportion of elderly persons grows. It demonstrates how the discomforts encountered in dementia, stroke, Parkinson's disease, ALS, Huntington's disease, muscular dystrophies and multiple sclerosis can benefit from the same comprehensive approach to palliation as has evolved in specialist care for cancer.

Foreword

xiii

Note on drugs and abbreviations

xvii

Section I Palliative management

(42)

Introduction to palliation

(9)

Palliation, palliative care and palliative management

(1)

`Hospice' and palliation in advanced cancer

(1)

Palliative management in neurology: an increasingly recognized need

(1)

Different trajectories of care for cancer and neurological disease

(2)

Palliation and neuroscience

(4)

Characteristics of palliation

(8)

It is patient-centred

(2)

It provides truthful information concerning disease status and prognosis

(1)

It offers support for family members

(2)

It maintains comprehensive care

(1)

It ensures continuity of care

(1)

It relies on teamwork and networking

(1)

It adjusts its approach in recognition of deterioration

(1)

It includes bereavement support

(2)

Nodal points in decision-making

(5)

Introducing a palliative management approach

(1)

Introducing palliative interventions

(1)

Timing the onset of the terminal phase

(1)

Referral to a palliative care team

(1)

Writing a `do not resuscitate' order

(1)

Introducing bereavement care

(1)

Common deficiencies in palliative management

(8)

Poor communication

(4)

Rigid professional boundaries

(1)

Ineffective networking

(1)

Poorly developed teamwork

(1)

Failure to maintain an accessible clinical record

(1)

Common themes in palliation practice

(10)

Holism

(1)

Recording of observations

(2)

Finding the best answer: innovation and experiment

(1)

Appropriate therapy regimens

(1)

Support of carers

(3)

Working alongside complementary and alternative medicine

(3)

Section II Major discomforts in advanced neurological illness

(82)

Fatigue

(2)

Problems with muscles and movement

(18)

Weakness

(2)

Disorders of muscle tone and contraction

(6)

Seizures

(4)

Involuntary movements

(2)

Drug-induced movement disorders

(2)

Syncope and falls

(2)

Bulbar symptoms

(5)

Impaired speech

(1)

Dysphagia

(3)

Fear of choking

(1)

Drooling

(2)

Respiratory symptoms

(7)

Dyspnoea

(1)

Hypoventilation

(1)

Assisted ventilation

(2)

Cough

(1)

Retained secretions

(2)

Gastrointestinal symptoms

(12)

Dry mouth

(1)

Candida infection

(1)

Dysphagia

(1)

Gastro--oesophageal reflux

(1)

Nausea and vomiting

(3)

Bowel dysfunction

(4)

Nutrition and hydration

(3)

Urological symptoms

(6)

Urinary retention

(1)

Urgency and bladder spasm

(1)

Urinary incontinence

(1)

Sexual dysfunction

(2)

Pain

(16)

Types and mechanisms of pain

(1)

The importance of early control of pain

(1)

Pain in neurology

(3)

Management of nociceptive pain

100

(5)

Neuropathic pain

105

(2)

Opioids in chronic pain

107

(1)

Central pain

108

(1)

Other strategies for difficult pain

109

(2)

Cognitive, behavioural and psychological symptoms

111

(9)

Cognitive impairment

111

(1)

Delirium, agitation and restlessness

112

(2)

Depression

114

(1)

Anxiety

115

(1)

Insomnia

116

(2)

Grief and bereavement

118

(2)

Miscellaneous symptoms

120

(5)

Temperature control and pyrexia

120

(1)

Sweating (hyperhidrosis)

120

(1)

Pruritis

121

(1)

Hiccups

122

(1)

Headache

123

(2)

Section III Major neurological conditions requiring palliation

125

(76)

Cerebrovascular disease: stroke

127

(5)

Supportive phase

127

(3)

The terminal phase

130

(2)

Demyelinating disease

132

(10)

Supportive phase

133

(6)

The terminal phase

139

(3)

Parkinson's disease and related disorders

142

(6)

The Supportive phase

142

(3)

The phase of transition

145

(1)

The terminal phase

146

(2)

Dementia

148

(7)

Symptom management in dementia

149

(3)

The terminal phase

152

(3)

Amyotrophic lateral sclerosis (motor neurone disease)

155

(11)

The palliative approach

155

(1)

Telling the bad news of ALS

156

(2)

Supportive phase

158

(5)

The terminal phase

163

(3)

Incurable Infections of the nervous system

166

(12)

Rabies

166

(2)

Creutzfeldt--Jakob disease

168

(2)

HIV-acquired immunodeficiency syndrome

170

(1)

The supportive phase of HIV infection

171

(2)

The need for consistent supervision

173

(1)

The terminal phase of HIV-AIDS

174

(4)

Muscular dystrophy

178

(5)

The supportive phase of care

178

(1)

Transition to the terminal phase: the issue of ventilation

179

(4)

Neuropathies

183

(3)

Huntington's disease

186

(5)

Supportive care of Huntington's disease

187

(1)

The terminal phase

188

(3)

Cerebral neoplasms

191

(6)

The Supportive phase

192

(2)

The terminal phase

194

(3)

Sequelae of traumatic brain injury

197

(4)

The Supportive phase

197

(1)

The terminal phase

198

(3)

Section IV Ethical issues

201

(22)

Consent and decision-making

203

(2)

Advance directives

205

(2)

Proxy decision-making

207

(2)

Ethical issues in states of disordered consciousness

209

(9)

Coma

209

(1)

Persistent vegetative state (PVS)

209

(3)

Minimally conscious state (MCS)

212

(1)

Locked-in syndrome (LIS)

212

(2)

The management of PVS

214

(4)

Terminal sedation

218

(1)

Euthanasia

219

(4)

Section V Appendices

223

(30)

Practical aspects of home care

225

(5)

Necessary supports

225

(1)

The home environment

226

(1)

Education for home carers

227

(1)

Common questions raised by home carers

227

(1)

Advantages of home care

228

(1)

The importance of a record in the home

228

(2)

Characteristics of an effective palliation service

230

(4)

An accepted place in National Health Planning

230

(1)

Palliation services are organized on a population basis

231

(1)

Palliation teams are established and maintained

231

(1)

Education for palliation is established

232

(2)

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Palliative Neurology

Summary

Table of Contents

Supplemental Materials

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