臨床神経学

第49回日本神経学会総会

<シンポジウム7-3>ALSの研究・治療はどこまできたか
日本におけるALS終末期

荻野 美恵子

北里大学医学部神経内科学〔〒228-8555 相模原市北里1-15-1〕

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)

(臨床神経, 48:973−975, 2008)
key words:筋萎縮性側索硬化症, 終末期ケア, 緩和ケア, オピオイド

(受付日:2008年5月17日)