Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease in adults (approximately 6,000 patients in Germany). ALS leads to progressive muscle paralysis, accompanied by muscle stiffness and inability to move, while the mind usually remains clear. Death occurs 3 to 5 years after the onset of the disease. The symptoms that arise over time and the psychosocial support for patients and their families present a challenge for the care team. This practice-oriented work provides concrete guidance for holistic palliative care in ALS. Each section describes specific problem-solving strategies tailored to the German healthcare context.