Treatment with IV cyclophosphamide may result in mild and temporary improvement in clinical status and may be considered an alternative treatment method. Since treatment is experimental, cyclophosphamide should be prescribed by the patient's attending neurologist, rather than the emergency physician. Treatment of pneumonia or urosepsis initially involves empiric use of a relatively broad-spectrum antibiotic or antibiotics effective against probable pathogens, after appropriate cultures and specimens for laboratory evaluation have been obtained. These medications include cephalosporins, fluoroquinolones, vancomycin, penicillins, and aminoglycosides. This agent may extend survival or time to tracheotomy.
Efficacy is unproven.
Once the muscles supporting respiration fail, patients must be placed on ventilatory support for survival. A tracheostomy may allow a patient to be kept alive for years in a locked-in state, a condition in which the patient is paralyzed and unable to move anything other than the eyes. Upon reaching this stage, some patients communicate using laser-guided computers that read ocular movement. In determining whether the patient requires admission, assess the patient's baseline level of function and the effect of any acute problems identified. Consider the patient's personal support system to ensure that necessary medical care will be available at home.