Disease‐modifying interventions
Abstract
ALS and other motor neuron disorders 2004 5(Suppl 1), 76â78 # 2004 ALS and other motor neuron disorders. All rights reserved. ISSN 1466-0822 76 Natural history is a moving target Disease-modifying interventions Edward Kasarskis University of Kentucky and VA Medical Center, Lexington KY, USA I will brieï¬y review the issues of nutrition and NIPPV as they impact upon the natural history of ALS with regard to survival. Nutrition is potentially affected during the course of ALS by progressive muscle weakness that leads to symptomatic dysphagia and eventually restricted food intake. From the respiratory perspective, the ALS patient passes through the 50% FVC event horizon to the point of respiratory failure. One of the issues facing us today is the availability and use of interventions for routine patient care that may, or may not, modify the natural progression of ALS to a state of dietary and respiratory failure. Standardizing the use of PEG (percutaneous endoscopic gastrostomy) and NIPPV (noninvasive positive pressure ventilation) appears to be a crucial element in the design of clinical trials in which survival is an endpoint. The treatment horizon of symptomatic dysphagia and a FVC of 50%, derives from the AAN Practice Parameters which were