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MND – Medication Delivery in Dysphagia — SCE Neurology MCQ

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EasyPeripheral Neuropathy & NeuromuscularMND – Medication Delivery in DysphagiaSCE Neurology

A 65-year-old man with motor neurone disease has progressive bulbar dysfunction. He can no longer take his medications orally due to severe dysphagia. His riluzole and levetiracetam (for comorbid epilepsy) need to be continued. What medication delivery route should be arranged?

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Correct answer: B — Convert to alternative routes: riluzole liquid formulation via PEG tube; levetiracetam liquid or IV formulation if PEG not yet placed

In MND with severe dysphagia, medications must be continued via alternative routes. Options include: PEG tube (if placed — allows liquid formulations or dispersible tablets), nasogastric tube (temporary), liquid/syrup formulations, transdermal patches (e.g. rotigotine for PD), subcutaneous infusions (for specific medications), and buccal/sublingual routes. Riluzole is available as a liquid formulation. Levetiracetam is available as liquid and IV formulations. Abrupt cessation of AEDs risks breakthrough seizures. A: Medications must continue. C: Not all medications are available as suppositories. D: Not all medications are suitable for SC delivery. E: MND is progressive — improvement is unlikely.

Reference: NICE NG42 MND (2016); BNF