Neurology - School of Medicine Dundee

Part of the School of Dundee and NHS Tayside

Motor Neurone Disease

Jump to MND information for clinicians

 

What is MND?

Motor neurone disease (MND) is a neurodegenerative condition affecting the brain and spinal cord. MND is characterised by the degeneration of primarily motor neurones, leading to muscle weakness.

 

There are several forms of MND:

 

·       Amyotrophic lateral sclerosis (ALS) is characterised by muscle weakness, wasting and stiffness and affects about 66% of people with MND.

·       Progressive bulbar palsy, in which the nerves first affected are those involved in speech and swallowing, and occurs in about 25% of people.

·       Progressive muscular atrophy, which lead to muscle weakness and wasting of either arms or legs first, and affects about 10% of people with MND.

·       Primary lateral sclerosis, which leads to muscle stiffness and has a longer prognosis of up to 10-15 years, and has no clear prevalence but is very rare.

 

 

The initial stages of MND may be one of these forms, but as the disease progresses the pattern of symptoms and signs become similar, with increasing muscle weakness in the person’s arms and legs, problems swallowing and communicating and weakness of the muscles used for breathing.

 

Every person diagnosed with MND has an individual progression of the disease.

 

Diagnosis of MND

 

There is no single test to diagnose motor neurone disease and every patient is different. The medical team decides which tests should be performed on a case by case basis. Tests are performed to look for supportive features of motor neurone disease and to look for other possible causes of symptoms. These tests include:

Magnetic Resonance Imaging (MRI)

Electromyography (EMG)

Nerve conduction tests (NCT)

Lumbar Puncture

Bloods

 

Treatment

 

Unfortunately there is no known cure for MND but treatments are used to improve symptoms. Riluzole, also known as Rilutek is presently the only licensed medication specifically approved for MND. It has been shown to have a small effect in slowing down the progression of MND. It is taken in tablet form twice each day and is available on the NHS.

Most people tolerate Riluzole, however side effects have been noted. The most common side effects include tiredness and letharhy. A small number of patients may experience elevated liver enzymes therefore blood tests need to be done on a regular basis. It can also make people more prone to getting infections. The majority of people do not experience any side effects but if they do, consideration should be given whether this treatment should continue.

 

Follow up

The MND clinic runs on the 1st Wednesday of every month. On alternative months a MND respiratory clinic runs alongside this. We work as part of a large MDT to ensure all symptoms are managed appropriately. Appointments to see other members of the MDT may include:

Speech and Language Therapist (SALT)

Occupational Therapist (OT)

Dietician

Neuropsychologist

Physiotherapist

Social Worker

 

 

Our Tayside MND service is led by Dr Ian Morrison, with support from MND nurse specialists.

Several pathways have been generated to assist in MND management. These are only available via the NHS Tayside intranet:

 

MND general management

Diagnostic pathway

MND and swallow

Palliative care and rehab roles

Respiratory function algorithm

 

Palliative care

Advanced care planning route map

Advanced care plan leaflet

Advanced care plan leaflet (Angus region)

Depression in palliative care scenarios

Palliation