Rinsho Shinkeigaku (Clinical Neurology)

The 49th Annual Meeting of the Japanese Society of Neurology

The end of life care for the patients with ALS in Japan

Mieko Ogino

Department of Neurology, Kitasato University School of Medicine

Because the whole of the management of ALS is palliative care, in this paper I presented about the management of each symptom, respiratory care, decision making of the mechanical ventilation, and the end of life care in Japan. We must be aware that the patients with ALS can continue to live if they decide to wear the tracheostomy ventilation (TV) even just before death, it is completely different form situation in cancer patients. In Japan about 20% of ALS patients choose TV, this figure is much higher than western countries. On the other hand, only 14% of neurologist have experience of opioids usage for ALS in 2007, much lower than western countries. We started to use opioids for ALS patients in 2005. We use morphine 10-30 mg/day as maintenance dose in early phase without sever side effect. Eighty-eight percent patients reported relief of breathlessness, in 4 patients out of 9, PCO2 was decreased. It is big problem that the health insurance does not cover the cost of opioids for ALS. I want to emphasize that the best effort should be taken to relieve suffering not only for cancer patient but for every patient.
Full Text of this Article in Japanese PDF (271K)

(CLINICA NEUROL, 48: 973|975, 2008)
key words: Amyotrophic lateral sclerosis (ALS), the end of life care, palliative care, opioid

(Received: 17-May-08)