End of Life Care of People with Long Term Neurological Conditions: Interface between Neurology, Neurorehabilitation and Palliative Care

Abstract

Neurologists address diagnosis, modification of disease course and management of symptoms of people with long-term neurological conditions such as Parkinson’s disease, multiple sclerosis, motor neuron disease and sequelae of stroke. Neurorehabilitation specialists focus on management of symptoms and alleviation of activity limitations. Palliative care specialists are involved in end-of-life care of these patients. Guidance and protocols of palliative care services have been directed towards the care of patients with cancer. While it may be possible to extrapolate some of these to people with long-term neurological conditions, there are obvious differences between the two groups. The time course of progressive neurological conditions varies widely between and within the disorders which make timing of initiation of these discussions challenging. Common issues during end-of-life care are when to start discussions about end-of-life care, advanced care planning, management of common symptoms, withdrawal of life-sustaining treatments, support for family and caregivers and when to involve specialist palliative care team. The unique social, economic and cultural aspects of India influence these decisions. End-of-life care cannot be seen in isolation and as such close collaboration between neurology, neurorehabilitation and specialist palliative care is imperative. In this article, we will discuss the end-of-life care of people with long-term neurological condition in India.

Keywords

• end of life
• long-term neurological conditions
• neurology
• neurorehabilitation
• palliative care