As there is no cure for MND, treatment focuses on relieving the symptoms and managing the progression of the disease. Early access to specialist care soon after diagnosis is vital and should be available in a setting of the person’s choice. You can find out more about treating MND in the section entitled Caring for someone with MND.
A range of treatments can relieve many of the symptoms of MND and improve quality of life.
Muscle cramps can be helped by physiotherapy and, in some cases, a medication called quinine. They typically improve later in the condition.
Muscle stiffness, also known as spasticity, may be helped by exercises recommended by a physiotherapist. Medication such as Baclofen to help relax the muscles is also a possibility.
Drooling or Sialorrhoea
Drooling of watery saliva can be treated with a number of medications. One widely used medication is a hyoscine hydrobromide skin patch. It was originally designed to treat motion sickness, but has since proved useful in drying up the flow of saliva. Amitriptyline, atropine eye drops applied under the tongue, glycopyrrolate, or botulinum toxin injections are alternative medicines that can also be used to control drooling.
Not everyone with MND will have significant speech problems, but there is help for people who do. A speech and language therapist can teach people several techniques to make their voices as clear as possible. As MND progresses, the person may need assistive technology to help them communicate. A range of communication aids are available and a speech therapist should advise the person about the most effective communication aids for them.
Not everyone with motor neurone disease will have significant swallowing problems (dysphagia). For those that do, it can compromise normal eating and drinking. If food goes down the wrong way into the lungs (called aspiration) it can cause chest infections. Weight loss due to poor nutrition can also accelerate the disease. One possible treatment for poor nutrition resulting from dysphagia is the use of a thin feeding tube known as a gastrostomy. In this procedure the tube is surgically implanted into the stomach through a small cut on the surface of the stomach. It shouldn’t restrict daily activities and the person can continue to bathe and swim normally if they wish. It’s advisable to have the tube inserted before the breathing muscles are significantly weakened, even if it isn’t used for feeding until sometime later.
If the person experiences pain, it’s often aching joints caused by muscle weakness or difficulty maintaining posture. The type of painkiller recommended will depend on how severe the pain is. Mild to moderate pain can often be controlled using non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. More severe pain can be treated using an opiate-based painkiller such as morphine.
As MND progresses, the muscles that help the person breathe will become weaker and their breathing will become increasingly shallow, with a weaker cough. Breathing difficulties usually develop gradually, although rarely they may be the first sign of MND. It’s important to discuss breathing problems with the person before they occur. Many people with MND benefit from non-invasive mechanical ventilation (NIV) to support their breathing, usually overnight when asleep. Room air (not oxygen) is sucked into a small box, filtered and then gently pumped into the lungs through a face mask or nasal tube each time the person takes a breath.
NIV may not be suitable for everyone with motor neurone disease. Their respiratory or palliative care specialist will be able to discuss the options available to them. Deciding what treatment the person wants to use in the event of respiratory failure is an important part of drawing up a treatment plan.
Some people with MND find complementary therapy helpful. This involves combining conventional treatments with non-medical treatments, such as acupuncture. Complementary therapies can’t slow the progression of MND, but they may help reduce stress and make daily life more comfortable.