Arianna Sartori1, Alessandro Dinoto2, Lara Stragapede2, Giulia Mazzon2, Maria Elisa Morelli2, Fulvio Pasquin2, Alessio Bratina2, Antonio Bosco2, Paolo Manganotti2. 1. Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy. sartoriarianna23@gmail.com. 2. Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
Abstract
BACKGROUND: Spasticity is a common and disabling symptom in patients with multiple sclerosis (PwMS): as highlighted by many epidemiological studies, it is often a severe and not well treated. Despite the availability of evidence-based spasticity management guidelines, there is still great variability in everyday therapeutic approach, especially for the most complex cases. METHODS: In our single-centre study, we retrospectively evaluated PwMS-treated nabiximols and botulinum toxin injections (BTI) from July 2015 to April 2019. Clinical and demographic data were collected. The severity of spasticity and spasms was recorded by modified Ashworth Scale (mAS) and Penn Spasm Frequency Scale (PSFS) at baseline and after 1 month of treatment. RESULTS: We evaluated 64 treatments for MS-related spasticity: 28 patients were treated with BTI and 36 patients with nabiximols. We found that both BTI and nabiximols are effective in reducing mAS (nabiximols, BTI: p < 0.001), PSFS frequency (nabiximols: p = 0.001, BTI: p = 0.008) and intensity (nabiximols: p = 0.001, BTI p = 0.016). No differences were found when directly comparing the efficacy of the two treatments, except for a statistical trend favouring BTI on spasms intensity (p = 0.091). Eleven patients were treated with both BTI and nabiximols, and only four patients continued both treatments. All dropouts were due to inefficacy of at least one of the two therapies. CONCLUSIONS: Our single-centre experience highlights that both BTI and nabiximols are effective in treating multiple sclerosis-related spasticity; however, BTI treatment may be more effective on spasms intensity. Combined nabiximols and BTI treatment could represent a therapeutic option for severe spasticity.
BACKGROUND: Spasticity is a common and disabling symptom in patients with multiple sclerosis (PwMS): as highlighted by many epidemiological studies, it is often a severe and not well treated. Despite the availability of evidence-based spasticity management guidelines, there is still great variability in everyday therapeutic approach, especially for the most complex cases. METHODS: In our single-centre study, we retrospectively evaluated PwMS-treated nabiximols and botulinum toxin injections (BTI) from July 2015 to April 2019. Clinical and demographic data were collected. The severity of spasticity and spasms was recorded by modified Ashworth Scale (mAS) and Penn Spasm Frequency Scale (PSFS) at baseline and after 1 month of treatment. RESULTS: We evaluated 64 treatments for MS-related spasticity: 28 patients were treated with BTI and 36 patients with nabiximols. We found that both BTI and nabiximols are effective in reducing mAS (nabiximols, BTI: p < 0.001), PSFS frequency (nabiximols: p = 0.001, BTI: p = 0.008) and intensity (nabiximols: p = 0.001, BTI p = 0.016). No differences were found when directly comparing the efficacy of the two treatments, except for a statistical trend favouring BTI on spasms intensity (p = 0.091). Eleven patients were treated with both BTI and nabiximols, and only four patients continued both treatments. All dropouts were due to inefficacy of at least one of the two therapies. CONCLUSIONS: Our single-centre experience highlights that both BTI and nabiximols are effective in treating multiple sclerosis-related spasticity; however, BTI treatment may be more effective on spasms intensity. Combined nabiximols and BTI treatment could represent a therapeutic option for severe spasticity.
Authors: Dirk Dressler; Roongroj Bhidayasiri; Saeed Bohlega; Pedro Chana; Hsin Fen Chien; Tae Mo Chung; Carlo Colosimo; Markus Ebke; Klemens Fedoroff; Bernd Frank; Ryuji Kaji; Petr Kanovsky; Serdar Koçer; Federico Micheli; Olga Orlova; Sebastian Paus; Zvezdan Pirtosek; Maja Relja; Raymond L Rosales; José Alberto Sagástegui-Rodríguez; Paul W Schoenle; Gholam Ali Shahidi; Sofia Timerbaeva; Uwe Walter; Fereshte Adib Saberi Journal: J Neurol Date: 2018-02-08 Impact factor: 4.849
Authors: A Novotna; J Mares; S Ratcliffe; I Novakova; M Vachova; O Zapletalova; C Gasperini; C Pozzilli; L Cefaro; G Comi; P Rossi; Z Ambler; Z Stelmasiak; A Erdmann; X Montalban; A Klimek; P Davies Journal: Eur J Neurol Date: 2011-03-01 Impact factor: 6.089