Skip to main content

The Management of Neurological Symptoms in Palliative Care

  • Living reference work entry
  • Latest version View entry history
  • First Online:
Textbook of Palliative Care

Abstract

Neurological disease is a major cause of disability and death across the world. There is increasing evidence that palliative care is effective in managing symptoms, maintaining and improving quality of life, and helping patients and families cope with the deterioration. As the disease progression varies, both between diseases and for individuals, palliative care may be involved for varying periods of time and may need to be involved episodically throughout the disease progression. Careful assessment of all the issues – physical, psychosocial, and spiritual – will allow appropriate management and support for patients and families. Carer support is very important as families face all the issues of coping with a progressive disease. Recognition of the later stages of life is helpful in enabling patients, families, and professionals to be able to prepare for the dying phase and manage all the issues appropriately.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  • Agar MR, Lawlor PG, Quinn S, Draper B, Caplan GA, Rowett D, Sanderson C, et al. Efficacy of oral risperidone, haloperidol or placebo for symptoms of delirium among patient in palliative care. A randomised controlled trial. JAMA Int Med. 2017;177:34–42.

    Article  Google Scholar 

  • Albanese A, Bhatia K, Bressman SB, Delong MR, Fahn S, Fung VS, Hallett M, Jankovic J, Jinnah HA, Klein C, Lang AE, Mink JW, Teller JK. Phenomenology and classification of dystonia: a consensus update. Mov Disord. 2013;28:863–73. https://doi.org/10.1002/mds.25475.

    Article  PubMed  PubMed Central  Google Scholar 

  • Allen RP, Picchietti D, et al. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated international restless legs syndrome study group (IRLSSG) consensus criteria – history, rationale, description and significance. Sleep Med. 2014;15:860–73.

    Google Scholar 

  • Alves G, Forsaa EB, et al. Epidemiology of Parkinson’s disease. J Neurol. 2008;5:18–32.

    Article  Google Scholar 

  • Anderson JF, Augoustakis LV, et al. End-of-life decision-making in individuals with locked-in syndrome in the acute period after brainstem stroke. Intern Med J. 2010;40:61–5.

    Article  CAS  PubMed  Google Scholar 

  • Bates D, Schultheis BC, Hanes MC, Jolly SM, Chakravarthy KV, Deer TR, Levy RM, Hunter CW. A comprehensive algorithm for the management of neuropathic pain. Pain Med. 2019;20:S2–S12.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bauer G, Gerstenbrand F, et al. Varieties of the locked-in syndrome. J Neurol. 1979;221:77–91.

    Article  CAS  PubMed  Google Scholar 

  • Bennett M. The LANSS pain scale: the Leeds assessment of neuropathic symptoms and signs. Pain. 2001;92:147–57.

    Article  CAS  PubMed  Google Scholar 

  • Bouhassira D, Attal N, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114:29–36.

    Article  PubMed  Google Scholar 

  • Bryan Young G. Stupor and coma in adults. UpToDate. 2015.

    Google Scholar 

  • Burges Watson DL, Campbell M, Hopkins C, et al. Altered smell and taste: anosmia, parosmia and the impact of long Covid-19. PLoS ONE. 2021;16(9):e0256998. https://doi.org/10.1371/journal.pone.0256998.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bush SH, Tierney S, Lawlor PG. Clinical assessment and management of delirium in the palliative care setting. Drugs. 2017;77:1623–43.

    Article  PubMed  PubMed Central  Google Scholar 

  • Calsina-Berna A, Garcia-Gomez G, Gonzales-Baboteo J, Porta-Sales J. Treatment of chronic hiccups in cancer patients: a systematic review. J Palliat Med. 2012;15:1142–50.

    Article  PubMed  Google Scholar 

  • Carlos K, Prado GF, et al. Benzodiazepines for restless legs syndrome. Cochrane Database Syst Rev. 2017;20(3):CD006939. https://doi.org/10.1002/14651858.

    Article  CAS  Google Scholar 

  • Costigan M, Scholz J, et al. Neuropathic pain: a maladaptive response of the nervous system to damage. Ann Rev Neurosci. 2009;32:1–32.

    Article  CAS  PubMed  Google Scholar 

  • Cruccu G, Truini A. Tools for assessing neuropathic pain. PLoS Med. 2009;6:e1000045.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cuenca J, Glazebrook C, Kendall T, Hedderly T, Heyman I, et al. BMC Psychiatry. 2015;15:46. Published online 11 Mar 2015. https://doi.org/10.1186/s12888-015-0430-0.

  • Dal Bello-Haas V, Florence JM, Krivickas LS. Therapeutic exercise for people with amyotrophic lateral sclerosis or motor neuron disease. Cochrane Database Syst Rev. 2013;2:CD005229.

    Google Scholar 

  • de Oliveira CO, Carvalho LB, et al. Opioids for restless legs syndrome. Cochrane Database Syst Rev. 2016;29(6):CD006941. https://doi.org/10.1002/14651858.

    Article  CAS  Google Scholar 

  • Didato G, Di Giacomo R, Rosa GJ, Dominese A, de Curtis M, Lanteri P. Restless legs syndrome across the lifespan: symptoms, pathophysiology, management and daily life impact of the different patterns of disease presentation. Int J Environ Res Public Health. 2020;17:3658. https://doi.org/10.3390/ijerph17103658.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dworkin RH, Backonja M, et al. Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Arch Neurol. 2003;60:1524–34.

    Article  PubMed  Google Scholar 

  • Dworkin RH, O’Connor AB, et al. Pharmacologic management of neuropathic pain: evidence based recommendations. Pain. 2007;132:237–51.

    Article  CAS  PubMed  Google Scholar 

  • Finucane AM, Lugton J, Kennedy C, Spiller JA. The experiences of caregivers of patients with delirium, and their role in its management in palliative care settings: an integrative literature review. Psychooncology. 2017;26:291–300.

    Article  PubMed  Google Scholar 

  • Finucane AM, Jones L, Leurent B, et al. Drug therapy for delirium in terminally ill adults. Cochrane Libr. 21 January 2020. https://doi.org/10.1002/14651858.CD004770.pub3

  • Fisher RS, van Emde BW, Blume W, et al. Epileptic seizures and epilepsy. Definition proposed by the international league against epilepsy and the International Bureau for Epilepsy. Epilepsia. 2005;46:470–2.

    Article  PubMed  Google Scholar 

  • Gaudreau JD, Gagnon P, Harel F, Tremblay A, et al. Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. Pain Symptom Manage. 2005;29(4):368–75.

    Article  Google Scholar 

  • Gronheit W, Popkirov S, Wehner T, Schlegel U, Wellmer J. Practical management of epileptic seizures and status epilepticus in adult palliative care patients. Front Neurol. 2018;9:595. https://doi.org/10.3389/fneur.2018.00595.

    Article  PubMed  PubMed Central  Google Scholar 

  • Haehner A, Boesveldt S, et al. Prevalence of smell loss in Parkinson’s disease – a multicenter study. Parkinsonism Relat Disord. 2009;15:490–4.

    Article  CAS  PubMed  Google Scholar 

  • Haehner A, Habersack A, et al. Early Parkinson’s disease patients on rasagiline present with better odor discrimination. J Neural Transm. 2015;122:1541–6.

    Article  CAS  PubMed  Google Scholar 

  • Haig AJ, Katz RT, et al. Mortality and complications of the locked-in syndrome. Arch Phys Med Rehabil. 1987;68:24–7.

    CAS  PubMed  Google Scholar 

  • Hain TC, Uddin M. Pharmacological treatment of vertigo. CNS Drugs. 2003;17:85–100.

    Article  CAS  PubMed  Google Scholar 

  • Hawkes C. Olfaction in neurodegenerative disorder. Adv Otorhinolaryngol. 2006;63:133–51.

    PubMed  Google Scholar 

  • Heckmann JG, Dinkel HP. Recovery of locked-in syndrome in central pontine myelinolysis. Am J Case Rep. 2013;14:219–20.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hershkovich O, Sakhnini M, Gara S, Caspi I, Lotan R. Acute metastatic spinal cord compression: urgent surgery versus radiotherapy and treatment result prediction versus actual results. Curr Oncol. 2022;29:7420–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hogl B, Comella C. Therapeutic advances in restless legs syndrome (RLS). Mov Disord. 2015;30:1574–9.

    Article  PubMed  Google Scholar 

  • Hoogwout SJ, Paananen MV, et al. Musculoskeletal pain is associated with restless legs syndrome in young adults. BMC Musculoskelet Disord. 2015;16:015–0765.

    Article  Google Scholar 

  • Hosie A, Davidson PM, Agar M, Sanderson CR, Phillips J. Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: a systematic review. Pall Med. 2013;27:486–98.

    Article  Google Scholar 

  • Hosomi K, Morris S, Sakamoto T, Taguchi J, Maruo T, et al. Daily repetitive transcranial magnetic stimulation for post stroke upper limb paresis in the subacute period. J Stroke Cerebrovasc Dis. 2016;25:1655–64.

    Article  PubMed  Google Scholar 

  • Hui D. Benzodiazepines for agitation in patients with delirium: selecting the right patient, right time and right indication. Curr Opin Support Palliat Care. 2018;12:489–94.

    Article  PubMed  PubMed Central  Google Scholar 

  • Inouye SK, van Dyck CH, Alessi CA. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Intern Med. 1990;113:941–8. https://doi.org/10.7326/0003-4819-113-12-941.

    Article  CAS  Google Scholar 

  • Jeon YS, Kearney AM, baker PG. Management of hiccups in palliative care patients. BMJ Support Palliat Care. 2018;8:1–6. https://doi.org/10.1136/bmjspcare-2016-001264.

    Article  PubMed  Google Scholar 

  • Jones S, Man WD, Gao W, Higginson IJ, Wilcock A, Maddocks M. Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease. Cochrane Database Syst Rev. 2016;10:CD009419.

    PubMed  Google Scholar 

  • Kaub-Wittemer D, Steinbuchel N, et al. Quality of life and psychosocial issues in ventilated patients with amyotrophic lateral sclerosis and their caregivers. J Pain Symptom Manag. 2003;26:890–6.

    Article  Google Scholar 

  • Kerber KA, Baloh RW. The evaluation of a patient with dizziness. Neurol Clin Pract. 2011;1:24–33.

    Article  PubMed  PubMed Central  Google Scholar 

  • Klockgether T. Ataxias. Parkinsonisms Relat Disord. 2007;13:S391–4.

    Article  Google Scholar 

  • Klockgether T. Sporadic ataxia with adult onset: classification and diagnostic criteria. Lancet Neurol. 2010;9:94–104.

    Article  CAS  PubMed  Google Scholar 

  • Kompanje EJ. End-of-life decision-making in patients with locked-in syndrome. Intern Med J. 2010;40:607–8. https://doi.org/10.1111/j.1445-5994.2010.02227.x.

    Article  CAS  PubMed  Google Scholar 

  • Kuehlmeyer K, Racine E, et al. Diagnostic and ethical challenges in disorders of consciousness and locked-in syndrome: a survey of German neurologists. J Neurol. 2012;259:2076–89.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kumar A, Weber MH, Gokaslan Z, et al. Metastatic spinal cord compression and steroid treatment: a systematic review. Clin Spine Surg. 2017;30:156–63.

    Article  PubMed  Google Scholar 

  • Lahrmann H, Grisold W. Locked-in syndrome. In: Voltz R, Bernat JL, Borasio GD, et al., editors. Palliative care in neurology. Oxford: Oxford University Press; 2004. p. 135–42.

    Google Scholar 

  • Lalviainen R, Reinikainen M. Management of prolonged epileptic seizures and status epilepticus in palliative care patients. Epilepsy Behav. 2019;1010:106288. https://doi.org/10.1016/j.yebeh.2019.04.041.

    Article  Google Scholar 

  • Laureys S, Pellas F, et al. The locked-in syndrome: what is it like to be conscious but paralyzed and voiceless? Prog Brain Res. 2005;150:495–611.

    Article  PubMed  Google Scholar 

  • Levack P, Graham J, Collie D, et al. Scottish Cord Compression Study Group. Don’t wait for a sensory level–listen to the symptoms: a prospective audit of the delays in diagnosis of malignant cord compression. Clin Oncol (R Coll Radiol). 2002;14:472–80.

    Article  CAS  PubMed  Google Scholar 

  • Macdonald GA, Lynch D, Garbett I, Nazeer N. Malignant spinal cord compression. J R Coll Physicians Edinb. 2019;49:151–6.

    Article  PubMed  Google Scholar 

  • Maddalena V, O’Shea F, et al. Palliative and end-of-life care in Newfoundland’s deaf community. J Palliat Care. 2012;28:105–12.

    Article  PubMed  PubMed Central  Google Scholar 

  • Malik FA, Hall EJ, Edmonds P. The palliative management of raised intra-cranial pressure. In: Booth S, Bruera E, editors. Primary and metastatic brain tumours. Oxford: Oxford University Press; 2004. p. 61–81.

    Chapter  Google Scholar 

  • Maschio M. Brain tumour-related epilepsy. Curr Neuropharmacol. 2012;10:124–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • McShane R, Nagy Z, et al. Anosmia in dementia is associated with Lewy bodies rather than Alzheimer’s pathology. J Neurol Neurosurg Psychiatry. 2001;70:739–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • MD Guidelines. 2017. Available from: http://www.mdguidelines.com/dizziness-and-giddiness.

  • Mercadante S, Porzio G, Valle A, Fusco F, Aielli F, Adile C, Casuccio A. Orphan symptoms in advance cancer patients followed at home. Support Care Cancer. 2013;21:3525–8.

    Article  PubMed  Google Scholar 

  • Mercadante S, Adile C, Ferrera P, Corttegiani A, Casuccio A. Delirium assessed by memorial assessment scale in advance cancer patients admitted to an acute palliative/supportive care unit. Curr Med Res Opin. 2017;33:1–16. https://doi.org/10.1080/03007995.2017.1315332.

    Article  Google Scholar 

  • Moisset X, Bouchassira D, Avez Couturier J, et al. Pharmacological and non-pharmacological treatments for neuropathic pain: systematic reviews and French recommendations. Rev Neurol. 2020;176:325–52.

    Article  CAS  PubMed  Google Scholar 

  • National Institute for Health and Care Excellence. Motor neurone disease: assessment and management. NICE Guideline NG 42. NICE; 2016. www.nice.org.uk/guidance/NG42

  • National Institute for Health and Care Excellence (NICE). Metastatic spinal cord compression in adults: risk assessment, diagnosis and management. 2008. www.nice.org.uk/guidance/cg75.

  • Nordin S, Paulsen JS, et al. Sensory- and memory-mediated olfactory dysfunction in Huntington’s disease. J Int Neuropsychol Soc. 1995;1:281–90.

    Article  CAS  PubMed  Google Scholar 

  • Ohayon MM, O’Hara R, et al. Epidemiology of restless legs syndrome: a synthesis of the literature. Sleep Med Rev. 2012;16:283–95.

    Article  PubMed  Google Scholar 

  • Panzer J, Dalmau J. Movement disorders in paraneoplastic and autoimmune disease. Curr Opin Neurol. 2011;24:346–53. https://doi.org/10.1097/WCO.0b013e328347b307.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pi J, Kang Y, Smith M, Earl M, Norigian Z, McBride A. A review in the treatment of oncologic emergencies. J Oncol Pharm Pract. 2016;22:625–38.

    Article  CAS  PubMed  Google Scholar 

  • Pickering G, Marcoux M, Chapiro S, David L, et al. An algorithm for neuropathic pain management in older people. Drugs Aging. 2016;33:575–83.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rades D, Segedin B, Schild SE, Lomidze D, Veninga T, Cacicedo J. Identifying patients with malignant spinal cord compression (MSCC) near end of life who can benefit from palliative radiotherapy. Radiat Oncol. 2022;17:143–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ramjit AL, Sedig L, et al. The relationship between anosmia, constipation, and orthostasis and Parkinson’s disease duration: results of a pilot study. Int J Neurosci. 2010;120:67–70.

    Article  CAS  PubMed  Google Scholar 

  • Regard C, Reynolds J, Watson B, Matthews D, Gibson L, Clarke C. Understanding distress in people with severe communication difficulties: developing and assessing the disability distress assessment tool (DisDAT). J Intellect Disabil Res. 2007;51:277–92.

    Article  Google Scholar 

  • Rouse S, Wodziak M. Intractable hiccups. Curr Neurol Neurosci Rep. 2018;18:51. https://doi.org/10.1007/s11910-018-0856-0.

    Article  PubMed  Google Scholar 

  • Rousseau MC, Baumstarck K, et al. Quality of life in patients with locked-in syndrome: evolution over a 6-year period. Orphanet J Rare Dis. 2015;10:88.

    Article  PubMed  PubMed Central  Google Scholar 

  • Roy D, Ghosh R, Dubey S, et al. Neurological and neuropsychiatric impacts of COVID-19 pandemic. Can J Neurol Sci. 2020;48:1–16. https://doi.org/10.1017/cjn.2020.173.

    Article  Google Scholar 

  • Savage P, Sharkey R, Kua T, Schofield L, Richardson D, et al. Malignant spinal cord compression: NICE guidance, improvements and challenges. Q J Med. 2014;107:277–82.

    Article  CAS  Google Scholar 

  • Schnakers C, Perrin F, et al. Detecting consciousness in a total locked-in syndrome: an active event-related paradigm. Neurocase. 2009;15:271–7.

    Article  PubMed  Google Scholar 

  • Scholz J, Mannion RJ, et al. A novel tool for the assessment of pain: validation in low back pain. PLoS Med. 2009;6:7.

    Article  Google Scholar 

  • Shprecher S, Kurlan R. The management of tics. Mov Disord. 2009;24:15–24. https://doi.org/10.1002/mds.22378.

    Article  PubMed  PubMed Central  Google Scholar 

  • Smith AK, Jain N, et al. Hearing loss in palliative care. J Palliat Med. 2015;18:559–62.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stec NE, Walbert T. Neuro-oncology and supportive care: the role of the neurologists. Neurol Sci. 2022;43:939–50.

    Article  PubMed  Google Scholar 

  • Tradounsky G. Seizures in palliative care. Can Fam Physician. 2013;59:951–5.

    PubMed  PubMed Central  Google Scholar 

  • Trenkwalder C, Allen R, Hogl B, Paulus W, Winkelmann J. Restless legs syndrome associated with major diseases: a systematic review and new concept. Neurology. 2016;86:1336–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Uecker FC, Olze H, et al. Longitudinal testing of olfactory and gustatory function in patients with multiple sclerosis. PLoS One. 2017;2(1):e0170492. https://doi.org/10.1371/journal.pone.0170492. eCollection 2017.

    Article  CAS  Google Scholar 

  • Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the pain assessment in advanced dementia (PAINAD) scale. J Am Med Dir Assoc. 2003;4:9–15.

    Article  PubMed  Google Scholar 

  • Weinstein BE. Palliative care: defining the role of the audiologist. Hear J. 2015;68:23–4.

    Article  Google Scholar 

  • Wijdicks EF, Bamlet WR, et al. Validation of a new coma scale: the FOUR score. Ann Neurol. 2005;58:585–93.

    Article  PubMed  Google Scholar 

  • World Health Organization. Palliative care. 2002. www.who.int/cancer/palliative/definition/en/. Accessed 26 July 2015.

  • Yeh P, Walters AS, et al. Restless legs syndrome: a comprehensive overview on its epidemiology, risk factors, and treatment. Sleep Breath. 2012;16:987–1007.

    Article  PubMed  Google Scholar 

  • Yorston D. The role of the ophthalmologist in advanced disease. In: Dunn G, Johnson A, editors. Surgical palliative care. Oxford Scholarship Online; 2004.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David Oliver .

Editor information

Editors and Affiliations

Section Editor information

Rights and permissions

Reprints and permissions

Copyright information

© 2024 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Oliver, D., Veronese, S. (2024). The Management of Neurological Symptoms in Palliative Care. In: MacLeod, R.D., Van den Block, L. (eds) Textbook of Palliative Care. Springer, Cham. https://doi.org/10.1007/978-3-319-31738-0_23-2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-31738-0_23-2

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-31738-0

  • Online ISBN: 978-3-319-31738-0

  • eBook Packages: Springer Reference Biomedicine and Life SciencesReference Module Biomedical and Life Sciences

Publish with us

Policies and ethics

Chapter history

  1. Latest

    The Management of Neurological Symptoms in Palliative Care
    Published:
    10 March 2024

    DOI: https://doi.org/10.1007/978-3-319-31738-0_23-2

  2. Original

    Neurological Symptoms
    Published:
    12 January 2018

    DOI: https://doi.org/10.1007/978-3-319-31738-0_23-1