LAUSR

Mindfulness is a meditation technique that trains a person to bring his attention to the internal and external experiences of the present moment. It encourages non-judgmental openness, curiosity and acceptance. The basis of mindfulness practices is that experiencing the present moment non-judgmentally and openly can counteract the effects of stressors of the past or future that can cause depression and anxiety. A metaanalysis of 29 studies that included 2668 subjects showed that mindfulness-based stress reduction (MBSR) is effective in reducing depression [1]. Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease of the upper and lower motor neurons that leads to weakness of bulbar, limb and truncal muscles. Patients with ALS suffer from inability to speak and swallow, immobility and eventual respiratory failure. Death from respiratory failure occurs on average 2–4 years after disease onset. ALS is not curable. However, several therapies are available. The European Federation of Neurological Societies [2] and the American Academy of Neurology [3,4] have published guidelines on the management of ALS. Riluzole is the only approved pharmacological treatment for ALS. It is therefore crucial to provide palliative care to patients with ALS to improve their quality of life (QOL). It is important to point out that QOL in patients with ALS does not correlate with measures of physical strength and function, and does not necessarily decline as the disease progresses. Psychological factors (such as depression), existential, religious/spiritual factors and support systems also play major roles. Whilst evidence-based medicine has shown that interventions such as ALS multidisciplinary clinics, non-invasive ventilation and enteral feeding prolong survival and improve QOL [2–5], no studies have examined whether treating a psychological condition such as depression improves QOL in patients with ALS. Depression has a negative impact on QOL in patients with ALS. Because of the progressive and irreversible nature of ALS, it is not unexpected to see high levels of depression in patients with ALS. Lou et al. [6] reported that, of the 25 patients with ALS, 11 reported significant depression and those with higher scores in depression (measured by the Center for Epidemiology Study-Depression) had lower scores in QOL (measured by the McGill Quality of Life Questionnaire). Thakore and Pioro [7] reported that, of the 1067 ALS patients seen at their clinic, 52% reported moderate or severe depression (measured by the Patient Health Questionnaire-9) and that depression had a detrimental effect on survival and QOL. Most experts recommend treating depression aggressively in patients with ALS [2–4]. Unfortunately, there has been no evidenced-based study to examine whether treating depression in ALS improves QOL or survival. In this issue of the European Journal of Neurology, Pagnini et al. [8] reported the first ever controlled trial examining the effect of a psychological intervention on depression and anxiety in patients with ALS. They conducted an open label, randomized clinical trial examining the effect of an ALS-specific MBSR for patients with ALS. They enrolled 100 patients with ALS within 18 months of their diagnosis. The participants were randomly assigned either to usual care or to an 8-week ALS-specific MBSR. The primary outcome was QOL, measured by the ALS-Specific Quality of Life Revised scale, and secondary outcomes included anxiety and depression (assessed with the Hospital Anxiety and Depression Scale). Participants were assessed at recruitment and after 2, 6 and 12 months. Because of the rapid progression and short survival of ALS, it is not surprising to see a high dropout rate in this year-long longitudinal study. Only 75, 43 and 29 participants remained in the study at 2-month, 6-month and 12-month follow-ups respectively. Despite the limitation of the high dropout, their study demonstrated that the MBSR group had better QOL and less depression. This study provides crucial implications in the care of patients with ALS. The study showed that the intervention group using ALS-specific MBSR reported better QOL and lower levels of depression compared to the patients receiving usual care. It is well documented that a high percentage of ALS patients suffer