Management

Question 1

What is the conservative management for motor neurone disease?

Answer 1

• Psychological and wellbeing support for patient and family from diagnosis.
• Early discussions regarding advanced care planning.
• Nutritional and swallowing support – early dietetic input, SALT, and potential PEG feeding in later disease.
• Respiratory support – regular pulmonary function testing (e.g., 3 monthly), NIV, and airway maintenance.

Question 2

What is the medical management for motor neurone disease?

Answer 2

• Riluzole – only DMARD licensed in the UK, prolongs survival by ~3 months on average.
• Spasticity agents (e.g., baclofen, tizanidine, botox).
• Anticholinergics (e.g., glycopyrronium) – for secretions.
• Pain management.

Question 3

What is the management for an acute episode of multiple sclerosis?

Answer 3

• High-dose steroid therapy with methylprednisolone.
• Plasmapheresis (if refractory to steroids).
• Treatment of the underlying cause of exacerbation (e.g., infection).

Question 4

What is the long-term conservative management for multiple sclerosis?

Answer 4

• Optimisation of modifiable risk factors – e.g., smoking cessation, weight loss, vitamin D supplementation.
• Immunisations.
• MDT input – physiotherapy, occupational therapy, SALT, social care, psychiatry.

Question 5

What is the long-term medical management for multiple sclerosis?

Answer 5

• DMARDs – oral (dimethyl fumarate) or injectable (e.g., beta-interferon).
• Monoclonal antibodies – alemtuzumab, natalizumab.
• Emerging: autologous haematopoietic stem cell transplantation.

Question 6

What is the conservative management for Parkinson’s disease?

Answer 6

MDT involvement – physiotherapy, SALT, Parkinson’s nurse specialist, occupational therapy.

Question 7

What is the medical management for Parkinson’s disease?

Answer 7

All medical tx. Focuses on replacing dopamine and reducing its breakdown.

• Levodopa – 1st line – precursor of dopamine. Taken in conjunction to carbidopa to reduce peripheral metabolism into dopamine, allowing the drug to cross the blood-brain barrier.
• Monoamine oxidase-B inhibitors (e.g., selegiline) – block breakdown of dopamine.
• Dopamine agonists (e.g., ropinirole) – bind to and stimulate dopamine receptors. Adverse effect: impulse control disorders.

Question 8

What is the specialised management for Parkinson’s disease refractory to medical treatment?

Answer 8

Deep brain stimulation.