Description
With the growth of neuropalliative care as a rapidly-emerging subspecialty in neurology, it is essential that clinicians develop core skills to offer high-quality, patient-centred care. This book captures the essence of palliative care in Neurology, highlighting abundant opportunities to incorporate key principles into patients' management plans. Through a pragmatic, case-based format with suggested references for readers to expand their knowledge on a range of topics, this guide explores didactic opportunities. From patients facing challenging end-of-life decisions, families struggling to determine the treatment intensities, to clinicians leading difficult conversations, these cases are straightforward and relatable. Demonstrating the breadth of palliative care opportunities occurring on the spectrum of neurologic disease, this essential toolkit supports clinicians at all levels, providing assistance for patients who have chronic, progressive, or terminal neurologic diseases. Compelling and thought-provoking, this guide highlights the many opportunities to ease suffering and to improve quality of life.
Table of Contents
List of contributors; Section 1. Palliative Care Principles: 1. The role of palliative medicine in neuropalliative care; 2. Common challenges in a palliative medicine consultation; 3. When is the right time to give up?; 4. A request for cognitive enhancement; 5. 'Doctor, how long does he have?'; 6. 'Will I walk again?' Prognostication in spinal cord compression; 7. Prolonged grief following the death of a spouse; 8. Mitigating bereavement risk following a sudden death; 9. 'I'm praying for a miracle'; 10. 'Should his devices be deactivated?'; 11. 'Is it time for hospice?'; Section 2. Cerebrovascular Diseases: 12. Temporary non-invasive ventilation in a do-not-intubate patient; 13. Stroke and end-stage heart failure; 14. Stroke and decompressive hemicraniectomy in a young patient; 15. Surrogate decision-making after a malignant MCA ischemic stroke; 16. A time-limited trial in a case of a basilar artery occlusion; 17. 'Mom never wanted a feeding tube'; 18. Painfully cold, numb, and weak: clinical characteristics and management of central post-stroke pain; 19. Shared decision-making for stroke patients; Section 3. Neurodegenerative and Neuromuscular Diseases: 20. Making a diagnosis with compassion in Parkinson's disease; 21. Caring for patients and families affected by advanced Parkinson's disease; 22. Cognitive decline in Parkinson disease; 23. Evolving goals of care as progressive supranuclear palsy progresses; 24. Psychosis and caregiver strain in Parkinson disease; 25. Constipation and Parkinson disease; 26. Keeping Mom home at the end of life; 27. 'I miss him already'; 28. The dynamic role of palliative medicine throughout the course of neuromuscular disease; 29. Considerations for non-invasive ventilation in neuromuscular disease; 30. Optimizing symptoms before a compassionate wean from the ventilator; 31. The case of a lost patch; 32. Dementia, delirium, and a distended bladder; Section 4. Neuro-Oncology: 33. 'I don't want to be a burden on my family'; 34. Palliative amputation for refractory pain; 35. Chemotherapy-induced peripheral neuropathy; 36. 'Two years may be too far away'; 37. Shifting the goals of care; 38. Management of seizures in patients with glioma from diagnosis through the end of life; 39. The burden of health care surrogacy in the absence of instruction; 40. 'But my brother should be treated'; 41. Taking flight at the end of life; Section 5. Pediatric Neurology: 42. Not another shunt revision; 43. Intrathecal baclofen for severe spasticity; Section 6. Demyelinating Diseases and Autoimmune Neurology: 44. Palliative care in multiple sclerosis: navigating chronic disease can be a difficult pill to swallow at a young age; 45. The perils of late advance care planning in multiple sclerosis; 46. Comparing and contrasting the approach to advance care planning in multiple sclerosis; 47. Comparing and contrasting the approach to advance care planning in multiple sclerosis; 48. Neuropsychological disturbances and fatigue in multiple sclerosis; 49. Pain and psychosocial symptoms in newly diagnosed neuromyelitis optica spectrum disorder (NMOSD); Index.
