From the Guidelines
For managing agitation in ALS patients, a stepwise approach prioritizing non-pharmacological interventions and considering the patient's overall care goals and advance directives is recommended. Begin with identifying and addressing underlying causes like pain, respiratory distress, or communication frustration, as emphasized in the palliative care approach for ALS patients 1. Create a calm environment, ensure proper positioning, and establish effective communication methods.
Some key non-pharmacological strategies include:
- Providing a predictable routine
- Allowing the patient to dress in their own clothing and keep possessions
- Explaining procedures and activities in simple language
- Simplifying tasks and using distraction and redirection
- Ensuring a safe environment
- Using calendars, clocks, labels, and newspapers for orientation
- Reducing excess stimulation and outings to crowded places 1
If medication is needed, SSRIs are considered first-line treatments for agitation due to their efficacy in reducing overall neuropsychiatric symptoms, agitation, and depression 1. For persistent agitation, consider adding other medications like benzodiazepines or antipsychotics, but with caution due to potential side effects. In severe cases, a combination approach may be necessary, and for end-stage agitation, palliative sedation might be appropriate. Regular reassessment is crucial to balance symptom control with side effects. Involve a multidisciplinary team including palliative care specialists when implementing this plan.
From the Research
Agitation Plan for ALS
- Agitation in patients with Amyotrophic Lateral Sclerosis (ALS) can be a significant concern, as it can lead to severe medical complications and death 2.
- There is no specific study on agitation plans for ALS patients, but multidisciplinary care has been recommended for managing ALS symptoms, including agitation 3, 4.
- Multidisciplinary care has been shown to improve survival and quality of life in ALS patients, and may also help manage agitation 4.
- Anxiety is a common issue in ALS patients and their caregivers, and can undermine quality of life 5.
- Selective Serotonin Reuptake Inhibitors (SSRIs) may be used to manage anxiety and depression in ALS patients, but their use in agitation management is not specifically studied 6.
- Identifying and managing agitation early is crucial, regardless of the treatment setting, and a multidisciplinary approach may be beneficial in managing agitation in ALS patients 2, 3, 4.