American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

American Academy of Neurology; American Academy of Neuromuscular and Electrodiagnostic Medicine
Practice Parameter Update: The Care of the Patient with Amyotrophic Lateral Sclerosis: Drug, Nutritional, and Respiratory Therapies (an Evidence-Based Review): Report of the Quality Standards Subcommittee of the American Academy of Neurology

Miller, R. G., Jackson, C. E., et al. (2009).
Neurology, 73(15), 1218-1226.

AGREE Rating: Highly Recommended

Description:

This guideline provides recommendations for the assessment and care of individuals with amyotrophic lateral sclerosis (ALS). This guideline and corresponding systematic review is an update of the 1999 Practice Parameter. The primary audience intended for this guideline is neurologists. The recommendations are classified A, B, C or U, based on the strength and consistency of evidence. Level A recommendations are "established as effective, ineffective or harmful" and based on evidence from consistent high quality randomized controlled trials (RCTs). Level B recommendations are "probably effective, ineffective or harmful" and based on evidence from a high quality RCT or consistent evidence from two or more lower quality RCTs. Level C recommendations are "possibly effective, ineffective or harmful" and based on evidence from at least one low quality RCT or consistent evidence from two or more controlled trials. Level U recommendations indicate that the data is "inadequate or conflicting" and therefore the treatment is unproven.

Recommendations:

  • Treatment
    • Swallowing
      • Oral versus Tube Feeding - Enteral nutrition via percutaneous endoscopic gastrostomy (PEG) should be considered to stabilize body weight for individuals with dysphagia (Level B Recommendation). There were no data to support or refute the specific timing of PEG insertion or for improving quality of life (Level U Recommendation). 

Keywords: Amyotrophic Lateral Sclerosis

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Added to Compendium: November 2011

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