Cover -- Half-title -- Title -- Copyright -- Contents -- Foreword -- Note on drugs and abbreviations -- SECTION I Palliative Management -- 1 Introduction to palliation -- PALLIATION, PALLIATIVE CARE AND PALLIATIVE MANAGEMENT -- 'HOSPICE' AND PALLIATION IN ADVANCED CANCER -- PALLIATIVE MANAGEMENT IN NEUROLOGY: AN INCREASINGLY RECOGNIZED NEED -- DIFFERENT TRAJECTORIES OF CARE FOR CANCER AND NEUROLOGICAL DISEASE -- Cancer -- Neurological diseases -- PALLIATION AND NEUROSCIENCE -- Palliation in an age of new, more successful therapies -- 2 Characteristics of palliation -- IT IS PATIENT-CENTRED -- IT PROVIDES TRUTHFUL INFORMATION CONCERNING DISEASE STATUS AND PROGNOSIS -- IT OFFERS SUPPORT FOR FAMILY MEMBERS -- Psychological support -- Physical support -- IT MAINTAINS COMPREHENSIVE CARE -- IT ENSURES CONTINUITY OF CARE -- IT RELIES ON TEAMWORK AND NETWORKING -- IT ADJUSTS ITS APPROACH IN RECOGNITION OF DETERIORATION -- IT INCLUDES BEREAVEMENT SUPPORT -- 3 Nodal points in decision-making -- INTRODUCING A PALLIATIVE MANAGEMENT APPROACH (Figure 1.3.1, Point 1) -- INTRODUCING PALLIATIVE INTERVENTIONS (Figure 1.3.1, Points 2) -- TIMING THE ONSET OF THE TERMINAL PHASE (Figure 1.3.1, Point 3) -- REFERRAL TO A PALLIATIVE CARE TEAM (Figure 1.3.1, Point 4) -- WRITING A 'DO NOT RESUSCITATE' ORDER (Figure 1.3.1, Point 5) -- INTRODUCING BEREAVEMENT CARE (Figure 1.3.1, Points 3-6) -- 4 Common deficiencies in palliative management -- POOR COMMUNICATION -- Communication aids -- What to say -- General principles -- Bad news -- Bad news in the supportive phase -- Bad news in the terminal phase -- RIGID PROFESSIONAL BOUNDARIES -- INEFFECTIVE NETWORKING -- POORLY DEVELOPED TEAMWORK -- FAILURE TO MAINTAIN AN ACCESSIBLE CLINICAL RECORD -- 5 Common themes in palliation practice -- HOLISM -- RECORDING OF OBSERVATIONS -- FINDING THE BEST ANSWER: INNOVATION AND EXPERIMENT.

APPROPRIATE THERAPY REGIMENS -- Ceasing unnecessary medications -- Administration of medications when swallowing is difficult -- SUPPORT OF CARERS -- Practical help -- Education -- Respite -- Advocacy -- Emotional support -- Carer fatigue and burnout -- Bereavement care -- WORKING ALONGSIDE COMPLEMENTARY AND ALTERNATIVE MEDICINE -- SECTION II Major Discomforts in Advanced Neurological Illness -- 1 Fatigue -- 2 Problems with muscles and movement -- WEAKNESS -- The supportive phase -- Terminal phase -- DISORDERS OF MUSCLE TONE AND CONTRACTION -- Spasticity -- Palliation in the supportive phase -- Botulinum toxin -- Intrathecal baclofen -- Palliation in the terminal phase -- Dystonia -- Muscle cramps -- SEIZURES -- Palliation of seizures in the supportive phase -- Pre-existing epilepsy -- Seizures arising as part of the neurological condition -- Management of seizures -- Status epilepticus -- Prophylactic treatment -- Palliation of seizures in the terminal phase -- INVOLUNTARY MOVEMENTS -- Myoclonus -- Tremor -- Restless legs -- DRUG-INDUCED MOVEMENT DISORDERS -- Serotonin syndrome -- Hemifacial spasm -- Tardive dyskinesia -- SYNCOPE AND FALLS -- 3 Bulbar symptoms -- IMPAIRED SPEECH -- The contribution of speech therapy/pathology -- DYSPHAGIA -- FEAR OF CHOKING -- DROOLING -- 4 Respiratory symptoms -- DYSPNOEA -- HYPOVENTILATION -- Nocturnal hypoventilation -- ASSISTED VENTILATION -- Ventilator issues associated with tracheostomy -- COUGH -- Assistance with coughing -- Suppression of cough -- RETAINED SECRETIONS -- Death rattle -- 5 Gastrointestinal symptoms -- DRY MOUTH -- CANDIDA INFECTION -- DYSPHAGIA -- GASTRO-OESOPHAGEAL REFLUX -- NAUSEA AND VOMITING -- Anti-emetic medications -- BOWEL DYSFUNCTION -- Constipation -- Bowel incontinence and diarrhoea -- Urine and bowel management in spinal injury -- NUTRITION AND HYDRATION -- Anorexia.

Nutritional support -- Withdrawing nutritional support -- Hydration -- 6 Urological symptoms -- URINARY RETENTION -- URGENCY AND BLADDER SPASM -- URINARY INCONTINENCE -- SEXUAL DYSFUNCTION -- 7 Pain -- TYPES AND MECHANISMS OF PAIN -- THE IMPORTANCE OF EARLY CONTROL OF PAIN -- PAIN IN NEUROLOGY -- Assessment of pain -- Medications for pain management -- The World Health Organization (WHO) ladder -- MANAGEMENT OF NOCICEPTIVE PAIN -- Starting an opioid -- Baseline and break-through (rescue) analgesic doses -- Side-effects of opioids -- NEUROPATHIC PAIN -- Recognition and assessment -- Management -- Membrane stabilizers -- Which drug? -- Anticonvulsants -- Antidepressants -- Antidysrhythmics -- OPIOIDS IN CHRONIC PAIN -- CENTRAL PAIN -- OTHER STRATEGIES FOR DIFFICULT PAIN -- Local opioids for pressure ulcer pain -- Ketamine -- Epidural and intrathecal drugs -- 8 Cognitive, behavioural and psychological symptoms -- COGNITIVE IMPAIRMENT -- DELIRIUM, AGITATION AND RESTLESSNESS -- The supportive phase -- Parenteral medications -- The terminal phase: 'terminal restlessness' -- DEPRESSION -- ANXIETY -- INSOMNIA -- GRIEF AND BEREAVEMENT -- 9 Miscellaneous symptoms -- TEMPERATURE CONTROL AND PYREXIA -- SWEATING (HYPERHIDROSIS) -- PRURITIS -- HICCUPS -- HEADACHE -- SECTION III Major Neurological Conditions Requiring Palliation -- 1 Cerebrovascular disease: stroke -- SUPPORTIVE PHASE -- Palliation issues -- Bulbar symptoms, swallowing and communication difficulties -- Maintenance of nutrition and hydration -- Immobility, pressure ulcers -- Pain -- Psychological symptoms: confusion, depression -- Bladder and bowel disturbances -- Venous thrombosis -- Chest infection -- Mortality and quality of life -- THE TERMINAL PHASE -- Palliation issues -- Site of care -- Management of discomfort: pain, restlessness, confusion.

Nutritional support, initiation and withdrawal of tube feeding -- 2 Demyelinating disease -- Diagnosis and prognosis -- SUPPORTIVE PHASE -- Palliation issues -- Prognosis uncertainty -- Management of relapses -- Importance of teamwork -- Information and support -- Use of alternative medicine -- Common symptoms -- Psychosocial issues -- Site of care -- THE TERMINAL PHASE -- Palliation issues -- Motor impairments: weakness, wasting, contractures -- Cognitive impairment: memory loss, poor concentration -- Psychological changes: lability of mood, depression -- Skin care -- Bowel management -- Administration of medications -- Management of terminal events -- Advance directives -- 3 Parkinson's disease and related disorders -- THE SUPPORTIVE PHASE -- Palliation issues -- Motor dysfunctions -- Autonomic dysfunctions: postural hypotension, abnormal sweating, erectile failure -- Cognitive impairment and psychological difficulties -- Drug therapy -- Non-drug therapies -- THE PHASE OF TRANSITION -- Palliation issues -- Place of neurosurgical intervention -- Cognitive and psychological impairment, hallucinations -- Motor impairment: dyskinesia, speech and swallowing difficulties -- Communication problems -- Bladder and bowel dysfunction -- Skin care -- THE TERMINAL PHASE -- Palliation issues -- Medications -- Sleep difficulty -- Skin care -- Sedation and analgesia -- 4 Dementia -- SYMPTOM MANAGEMENT IN DEMENTIA -- Palliation issues -- Appropriate medications -- Family support -- Symptom recognition, including pain -- Psychological difficulties: agitation and disruptive behaviour -- Ethical issues -- The maintenance of dignity -- THE TERMINAL PHASE -- Palliation issues -- Prognosis: management of incidental disease -- Feeding issues -- Symptom recognition and management -- Decision-making: advance directives and appointment of a proxy -- Post-mortem examination.

5 Amyotrophic lateral sclerosis (motor neurone disease) -- THE PALLIATIVE APPROACH -- TELLING THE BAD NEWS OF ALS -- End-of-life discussion -- Advance directives (also pp. 205-206) -- Supervision of care -- SUPPORTIVE PHASE -- Palliation issues -- Muscle weakness: spasm, fasciculations, spasticity -- Progressive hypoxia: assisted ventilation -- Speech difficulty, communication issues -- Swallowing dysfunction -- Drooling, management of secretions -- Bladder and bowel difficulties -- Constipation -- Sleep disturbance -- Psychological difficulties: inappropriate moods -- Pain -- THE TERMINAL PHASE -- Palliation issues -- Hypoxia and drowsiness from respiratory muscle weakness -- Pain from immobile limbs, pressure areas -- Accumulation of secretions -- Anxiety and fear of choking -- Depression and frustration -- Requests for euthanasia -- Exhaustion and burn-out among carers -- 6 Incurable infections of the nervous system -- RABIES -- Palliation issues -- Adequate sedation -- Reduction in oral secretions -- Continuous supervision to ensure titration of medication achieves comfort -- CREUTZFELDT-JAKOB DISEASE -- Palliation issues -- Delirium, cognition disturbance, changes in personality, psychosis -- Myoclonus -- Neuropathic pain and dysaesthesia -- Nutrition and hydration -- Effect on carers of the inevitable nature of the disease -- HIV-ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) -- The initial phase of HIV infection -- THE SUPPORTIVE PHASE OF HIV INFECTION -- Palliation issues -- Surveillance for adherence to treatment and co-morbidities -- Delirium and dementia, psychiatric issues -- Neuropathic pain -- Symptom management -- Fatigue -- THE NEED FOR CONSISTENT SUPERVISION -- THE TERMINAL PHASE OF HIV-AIDS -- Palliation issues -- Transition to a palliative approach -- Suitable site of care -- Staff attitudes and protection.

Cognitive dysfunction and dementia.