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Stroke, Epilepsy, and Neurological Diseases

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Essentials of Palliative Care

Abstract

Current opinion in neurology is to integrate palliative aid before the final stage of neurological disease. This concept has been applied to stroke, epilepsy, and general aspects of other neurological diseases. Stroke results in high levels of mortality and morbidity, after the acute initial period in which the patient may die, stroke patients tend to be chronically ill patients that need multidisciplinary support. In this sense, for most stroke patients, palliative care is not related to end-of-life support, but it refers to the measures that reduce disability and impairment. Most treatment techniques focus on disability reduction, patients must learn new strategies to solve common problems of daily life. Patients with have drug-resistant epilepsy (DRE) have an increased mortality rate. When a patient does not respond to medical or conventional surgical treatment, there are some options of palliative care; such as non-conventional surgical treatments, ketogenic diet, and vagus nerve stimulation. Palliative care of the other neurological diseases included in this article share common aspects such as communication, advanced care planning, and management of common neurological symptoms, including: dyspnea, death rattle, terminal restlessness, delirium, drowsiness, epileptic terminal seizures, pain, nausea and vomiting, and depression.

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Author information

Authors and Affiliations

  1. Neurology Department, Ciudad Real General University Hospital, Ciudad Real, Castilla–La Mancha, Spain

    María Gudín Ph.D.

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  1. María Gudín Ph.D.
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Correspondence to María Gudín Ph.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Yale University, New Haven, 06520, Connecticut, USA

    Nalini Vadivelu

  2. Citrus Road 278, River Ridge, 70123, Louisiana, USA

    Alan David Kaye

  3. Keck School of Medicine, Department of Anesthesiology, Pain Medic, of the University of Southern California, Los Angeles, 90035, California, USA

    Jack M. Berger

Appendices

Review Questions

  1. 1.

    Current opinion in neurology is to integrate palliative aid before the final stage of neurological disease. Please, mark the correct answer:

    1. (a)

      The last 6 months

    2. (b)

      The last 2 weeks

    3. (c)

      The last hours

    4. (d)

      When a permanent deficit is established that will short the patient life

  2. 2.

    Initially care of stroke must focus on:

    1. (a)

      Feeding

    2. (b)

      Excretional function

    3. (c)

      Airways projection

    4. (d)

      All of the above

  3. 3.

    Patients with stroke should routinely receive pharmacological venous thromboembolism (VTE) prophylaxis. Mark wrong answer:

    1. (a)

      The VTE prophylaxis must be started within 48 h in patients with acute ischemic stroke

    2. (b)

      The VTE prophylaxis must be continued for approximately 14 days in patients with acute ischemic stroke

    3. (c)

      Patients with acute hemorrhagic stroke should routinely receive mechanical prophylaxis

    4. (d)

      Pharmacological prophylaxis is never used in acute hemorrhagic stroke

    5. (e)

      Patients with neuromuscular degenerative diseases and with other major risk factors for venous thrombosis should be considered for the administration of pharmacological or mechanical prophylaxis

  4. 4.

    Patients with epilepsy whose seizures do not successfully respond to antiepileptic drug (AED) therapy are considered to have drug-resistant epilepsy (DRE). Mark the wrong statement:

    1. (a)

      This condition is also referred to as intractable, medically refractory, or pharmacoresistant epilepsy

    2. (b)

      As many as 20–40 % of patients with epilepsy are likely to have refractory epilepsy

    3. (c)

      Individuals with DRE do not have an increased mortality rate

    4. (d)

      The risk of sudden unexpected death (SUD) is closely related to seizure frequency

  5. 5.

    When a drug-resistant epilepsy patient does not respond to medical or conventional surgical treatment, there are some options of palliative care, such as:

    1. (a)

      Hemispherectomy

    2. (b)

      Corpus callosotomy

    3. (c)

      Multiple subpial transections

    4. (d)

      Ketogenic diet

    5. (e)

      Vagus nerve stimulation

    6. (f)

      All of the above

  6. 6.

    About dyspnea, say which of the answers is wrong:

    1. (a)

      The antidyspneic medication must ameliorate the respiratory awareness, but preserving the ventilatory drive

    2. (b)

      A respiratory rate of 15–20/min must be attempted

    3. (c)

      Opioids in modest doses have been demonstrated to give effective relief of dyspnea, whether or not identifiable reversible causes exist

    4. (d)

      A dose of 50 mg diazepam has a positive effect on improving sleep duration without worsening nocturnal hypoxemia

    5. (e)

      In rare cases where symptomatic treatment is unable to control dyspnea to the patient’s satisfaction, sedation is an effective, ethical option

  7. 7.

    There are treatable causes of terminal restlessness such as:

    1. (a)

      Pain

    2. (b)

      A distended bladder or rectum

    3. (c)

      Cerebral anoxia

    4. (d)

      Dyspnea

    5. (e)

      A paradoxical reaction to benzodiazepines

    6. (f)

      A response to anticholinergic drugs

    7. (g)

      All of the previous answers are treatable causes of terminal restlessness

Answers

  1. 1.

    (d) When a permanent deficit is established that will short the patient life

  2. 2.

    (d) All of the above

  3. 3.

    (d) Pharmacological prophylaxis is never used in acute hemorrhagic stroke

  4. 4.

    (c) Individuals with DRE do not have an increased mortality rate

  5. 5.

    (f) All of the above

  6. 6.

    (d) A dose of 50 mg diazepam has a positive effect on improving sleep duration without worsening nocturnal hypoxemia

  7. 7.

    (g) All of the previous answers are treatable causes of terminal restlessness

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Gudín, M. (2013). Stroke, Epilepsy, and Neurological Diseases. In: Vadivelu, N., Kaye, A., Berger, J. (eds) Essentials of Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5164-8_16

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  • DOI: https://doi.org/10.1007/978-1-4614-5164-8_16

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