[Nutritional management in amyotrophic lateral sclerosis: palliative and end-of-life care]

Nutritional intervention in neurological diseases including amyotrophic lateral sclerosis (ALS) has drawn attention in recent years. Malnutrition or progressive weight loss in the early stage of ALS has been reported as a predictor of poor survival prognosis. Percutaneous endoscopic gastrostomy (PEG) is recommended in the early stage of ALS to stabilize the body weight and possibly to improve patients' quality of life (QOL) or survival prognosis. Clinicians should be precisely aware of clinical significance and purposes, and optimal timing of PEG in ALS. PEG should be performed in the stages with preserved respiratory function (forced vital capacity > 50%, and arterial carbon dioxide pressure < 45 mmHg), to avoid early death after PEG and to maintain QOL with nutritional intervention through PEG. Although appropriate amount of energy to be administered is yet to be established, high calorie diet is expected to be effective for potential improvement of survival. PEG is also necessary as a safe administration route of opioids for palliative and end-of-life care.