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Sacco R, Riccitelli GC, Disanto G, Bogousslavsky J, Cavelti A, Czell D, Kamm CP, Kliesch U, Ramseier SP, Gobbi C, Zecca C. Effectiveness, Safety and Patients' Satisfaction of Nabiximols (Sativex ®) on Multiple Sclerosis Spasticity and Related Symptoms in a Swiss Multicenter Study. J Clin Med 2024; 13:2907. [PMID: 38792448 PMCID: PMC11122311 DOI: 10.3390/jcm13102907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Cannabinoid oro-mucosal spray nabiximols is approved for patients with moderate to severe multiple sclerosis spasticity (MSS) resistant to other antispastic medications. Few real-world data are available on the effectiveness, safety and patients' satisfaction in MS patients treated with nabiximols as monotherapy. Methods: To investigate the effectiveness, tolerability and satisfaction of nabiximols in a real-life multicentric Swiss cohort as monotherapy or with stable doses of other antispastic medications, and explore clinical features which may predict treatment response. The following data were collected at treatment start (baseline) and 12 weeks thereafter: Modified Ashworth scale (MAS), scores at numerical rating scales ranging from 0 (absent) to 10 (considerable) for effect on spasticity (sNRS), pain (pNRS), gait (gNRS), urinary symptoms (uNRS), tolerability (tNRS) as assessed by the treating neurologist, and overall treatment satisfaction (TsNRS) and tolerability (tNRS) as assessed by the patient. Results: Ninety-five patients (44 relapsing remitting, 37 secondary progressive and 14 primary progressive MS; median age = 53 (IQR 45-62); female 70%; median EDSS 6 (IQR 4-6), concomitant antispastic treatments in 54% of patients) were included. From baseline to week 12, median MAS score decreased from 3.0 to 2.0 (p < 0.001). Median scores of the each NRS also significantly decreased (p < 0.001 for all comparisons). At week 12, the median TsNRS and tTS scores were 8/10 (IQR: 6-9) and 9/10 (IQR: 7-10), respectively, and 93.7% of patients continued to use nabiximols at the average dose of six sprays/day. No clinical factors, including use of nabiximols as add on vs. monotherapy, were associated with responder status. Conclusions: Our first Swiss, multicentric, observational, real-life study supports and enhances previous finding of nabiximols as monotherapy and as add-on therapy, being an effective, safe and well-tolerated treatment option for resistant MS spasticity and spasticity-related symptoms (pain, bladder dysfunction and gait).
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Affiliation(s)
- Rosaria Sacco
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland; (R.S.); (G.C.R.); (G.D.); (C.G.)
| | - Gianna Carla Riccitelli
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland; (R.S.); (G.C.R.); (G.D.); (C.G.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Giulio Disanto
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland; (R.S.); (G.C.R.); (G.D.); (C.G.)
| | - Julien Bogousslavsky
- Neurocenter, Swiss Medical Network, Clinique Valmont, 1823 Montreux, Switzerland;
| | | | - David Czell
- NeuroMedics, Praxis Neurologie Uster, 8610 Uster, Switzerland;
| | | | - Uta Kliesch
- Neurologische Praxis Schwyz—Zug, 6430 Schwyz, Switzerland;
| | | | - Claudio Gobbi
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland; (R.S.); (G.C.R.); (G.D.); (C.G.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Chiara Zecca
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland; (R.S.); (G.C.R.); (G.D.); (C.G.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
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Guger M, Hatschenberger R, Leutmezer F. Non-interventional, prospective, observational study on spasticity-associated symptom control with nabiximols as add-on therapy in patients with multiple sclerosis spasticity in Austria. Brain Behav 2023; 13:e2947. [PMID: 36934456 PMCID: PMC10097150 DOI: 10.1002/brb3.2947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND AND PURPOSE Randomized controlled trials and observational studies of nabiximols oromucosal spray in patients with multiple sclerosis (MS) spasticity have shown improvement in a range of associated symptoms (pain, spasms, fatigue, bladder dysfunction, and sleep disturbances). This study evaluated the effectiveness and tolerability of add-on nabiximols in the routine management of patients with MS spasticity in Austria, with a focus on spasticity-associated symptoms. METHODS This was an open, prospective, multicenter, observational, non-interventional study of patients with MS spasticity receiving add-on treatment with nabiximols oromucosal spray. Main endpoints were patient-reported changes from baseline in the frequency (counts) or severity (mean Numerical Rating Scale [NRS] scores) of spasticity-associated symptoms, and patient-reported changes from baseline in impairment of daily activities due to spasticity, after 1 and 3 months of nabiximols treatment. No analyses were conducted for statistical significance. RESULTS There were 55 patients in the effectiveness population, and 62 in the safety population. Patients reported clinically relevant reductions from baseline to month 3 in the average number of spasms/day (-68.2%) and number of urinary incontinence episodes (-69.3%) in the week prior to the clinic visit, and reductions in mean 0-10 NRS scores for sleep impairment (-47.2%), fatigue (-26.4%), pain (40.4%), and spasticity severity (39.0%). There was no change from baseline in daily activity impairment due to spasticity. The majority of patients were at least partly satisfied with add-on nabiximols for spasticity-associated symptoms. There were 31 adverse events (27 treatment related) reported in 19 patients, with no new safety signals. CONCLUSIONS Add-on nabiximols improved the severity of MS spasticity and a range of spasticity-associated symptoms during real-world use in Austria. Nabiximols is an option for patients with MS spasticity who fail first-line oral antispasticity treatment.
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Affiliation(s)
- Michael Guger
- Department of Neurology, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Austria
| | - Robert Hatschenberger
- Department of Neurology, Klinikum Bad Hall and Bad Schallerbach, Bad Schallerbach, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University Vienna, Vienna, Austria
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Özkan İ, Polat Dunya C, Demir S. Life Experiences of Patients With Multiple Sclerosis About Their Spasticity: A Phenomenological Study. Clin Nurs Res 2023; 32:49-59. [PMID: 36154305 DOI: 10.1177/10547738221119346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Spasticity is one of the main symptoms that is most common in patients with Multiple Sclerosis and causes increased disability. The aim of this study is to understand the experiences of patients with Multiple Sclerosis about their spasticity from their perspective. This study was conducted as a qualitative study with a Hermeneutic phenomenological framework. The data were evaluated by using VanManen's thematic analysis method. As a result of the data analysis, four main themes were elicited, namely, "the meaning of spasticity for the patient," "the difficulties of living with spasticity," 'coping with spasticity," and "the new me created by spasticity." It was understood that spasticity is a symptom that brings about difficulties in psychological, social, and working life as well as physical difficulties. Nurses should be aware of the psychological symptoms as well as the physical symptoms that patients experience due to spasticity and should create a patient-specific management program.
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Affiliation(s)
| | | | - Serkan Demir
- Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey
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Newsome SD, Thrower B, Hendin B, Danese S, Patterson J, Chinnapongse R. Symptom burden, management and treatment goals of people with MS spasticity: Results from SEEN-MSS, a large-scale, self-reported survey. Mult Scler Relat Disord 2022; 68:104376. [PMID: 36544321 DOI: 10.1016/j.msard.2022.104376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/12/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Spasticity occurs frequently in people with multiple sclerosis (PwMS) and may affect non-physical aspects of life. However, there is a paucity of data assessing the full impact of spasticity in PwMS. OBJECTIVE This survey of PwMS and spasticity (PwMSS) was undertaken to understand the impact of spasticity in physical, functional, emotional, and social domains. METHODS SEEN-MSS (Symptoms and Emotions Exploration Needed in Multiple Sclerosis Spasticity), an online survey, was developed in collaboration with three US-based MS organizations (conducted February-April 2021). RESULTS Survey was completed by 1,177 PwMSS, 78% female, mean age 56.8yrs, 16.8yrs from MS diagnosis, 11.5yrs with spasticity. Considering day-to-day goals of treatment, respondents reported that managing symptoms(46%) was nearly as important as slowing disease progression(54%). Most reported spasticity was a constant reminder of their MS. Participants reported that spasticity limited daily activities (92%), caused pain (92%), impaired sleep (89%) and negatively impacted emotional well-being (87%). Spasticity fostered a sense of dependence (61%), isolation (40%), decline in self-confidence (75%), self-image (70%), and social connection (62%). CONCLUSIONS Spasticity has wide-reaching negative impacts on multiple aspects of life, causing substantial burden for PwMSS. Results emphasize the need to fully understand the burden of spasticity and addressing individual needs of PwMSS.
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Affiliation(s)
- S D Newsome
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - B Thrower
- Andrew C. Carlos Multiple Sclerosis Institute, Atlanta, USA
| | - B Hendin
- Department of Neurology, University of Arizona Medical School, Tucson, USA
| | - S Danese
- Outcomes Insights, Agoura Hills, USA
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Khalifeloo M, Naghdi S, Ansari NN, Dommerholt J, Sahraian MA. Dry needling for the treatment of muscle spasticity in a patient with multiple sclerosis: a case report. Physiother Theory Pract 2022; 38:3248-3254. [PMID: 34546842 DOI: 10.1080/09593985.2021.1978118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Spasticity is a common cause of disability in multiple sclerosis (MS), which can negatively affect the patient's walking and balance. OBJECTIVE To evaluate the immediate effect of dry needling (DN) on spasticity and mobility in a female with MS. CASE DESCRIPTION In this case, a 38-year-old female with a 4-year history of MS was treated. The hamstring muscles (biceps femoris and semitendinosus) were needled for 1 minute in a single session. The main outcome measures were the Modified Modified Ashworth Scale (MMAS) to evaluate spasticity, the Timed 25-Foot Walk (T25FW) for the assessment of mobility and leg function performance, and stiffness as a biomechanical index of spasticity measured by a dynamometer. The assessments were done before and immediately after DN. OUTCOMES The MMAS scores decreased in the hamstrings (1 to 0) and quadriceps (2 to 1). The mobility improved as the time for T25FW decreased from 16.30 to 9.29 seconds. The stiffness of hamstring decreased after treatment (0.451 to 0.312). CONCLUSION One session of DN for the hamstring muscle decreased spasticity and improved mobility in this patient with MS. Further studies are suggested.
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Affiliation(s)
- Maede Khalifeloo
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Ali Sahraian
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
- Sina Ms Research Center, Brain and Spinal Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Vitturi BK, Rahmani A, Dini G, Montecucco A, Debarbieri N, Bandiera P, Battaglia MA, Manacorda T, Persechino B, Buresti G, Ponzio M, Inglese M, Durando P. Spatial and temporal distribution of the prevalence of unemployment and early retirement in people with multiple sclerosis: A systematic review with meta-analysis. PLoS One 2022; 17:e0272156. [PMID: 35901070 PMCID: PMC9333213 DOI: 10.1371/journal.pone.0272156] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background We aimed to summarise the prevalence of unemployment and early retirement among people with MS and analyze data according to a spatio-temporal perspective. Methods We undertook a systematic search of PubMed/MEDLINE, Scopus, SciVerse ScienceDirect, and Web of Science. We included any peer-reviewed original article reporting the prevalence of unemployment and early retirement in the working-age population with MS. We excluded articles off-topic, with other study designs, whose study sample were unlikely to be representative of the MS population and in case of unavailability of the full text or essential information. A random-effects meta-analysis was used to measure overall prevalence estimates of unemployment and early retirement. We used meta-regression and subgroup analysis to evaluate potential moderators of prevalence estimates and the leave-one-out method for sensitivity analyses. Results Our research identified 153 studies across 29 countries encompassing 188436 subjects with MS. The pooled overall effect size for unemployment and early retirement was 35.6% (95% CI 32.8–38.4; I2 = 99.31) and 17.2% (95% CI 14.6–20.2; I2 = 99.13), respectively. The prevalence of unemployment varied according to the year of publication (p < 0.001) and there was a statistically significant decrease in the prevalence of unemployment over time (p = 0.042). Regarding early retirement, only seven (31.8%) estimates obtained from studies that were published before 2010 were below the overall effect size in comparison to 27 (60.0%) estimates extracted from data published between 2010 and 2021 (p = 0.039). There was a significant difference in prevalence according to countries (p < 0.001). Psychiatric illness was an important clinical feature responsible for patients leaving the workforce in regions with a high MS prevalence. Conclusions Unemployment and early retirement due to MS remain highly prevalent, despite a slight decline in the last decade. The prevalence of unemployment and early retirement varies globally.
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Affiliation(s)
| | - Alborz Rahmani
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Alfredo Montecucco
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Nicoletta Debarbieri
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
| | - Paolo Bandiera
- Italian Multiple Sclerosis Association (AISM), Genoa, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- Department of Life Science, University of Siena, Siena, Italy
| | - Tommaso Manacorda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | | | | | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Occupational Medicine Unit, Genoa, Italy
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Andreu-Caravaca L, Ramos-Campo DJ, Chung LH, Rubio-Arias JÁ. Can strength training modify voluntary activation, contractile properties and spasticity in Multiple Sclerosis?: a randomized controlled trial. Physiol Behav 2022; 255:113932. [PMID: 35905806 DOI: 10.1016/j.physbeh.2022.113932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/18/2022] [Accepted: 07/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND A randomized controlled trial was conducted to analyze the effects of 10 weeks of strength training (ST) on voluntary activation, muscle activity, muscle contractile properties, and spasticity in people with MS. METHODS 30 participants were randomized to either an experimental [EG](n=18) or a control [CG](n=12) group. The EG carried out 10-weeks of ST, where the concentric phase at maximum voluntary velocity. Muscle activity of the vastus lateralis (surface electromyography (sEMG) during the first 200 ms of contraction), maximal neural drive (peak sEMG), voluntary activation (central activation ratio), and muscle contractile function (via electrical stimulation) of the knee extensor muscles, as well as spasticity, were measured pre- and post-intervention. RESULTS The EG showed a significant improvement with differences between groups in muscle activity in EMG0-200 (p=0.031;ES=-0.8) and maximal neural drive (p=0.038;ES=-0.8), as well as improvement in the ST group with a trend towards significance in EMG0-100 (p=0.068;ES=-0.6). CAR increased after intervention in ST group (p=0.010;ES=-0.4). Spasticity also improved in the ST group, with differences between group after intervention, in first swing excursion (right leg: p=0.006;ES=-1.4, left leg: p=0.031;ES=-1.2), number of oscillations (right leg: p=0.001;ES=-0.4, left leg: p=0.031;ES=-0.4) and duration of oscillations (left leg: p=0.002; ES=-0.6). Contractile properties remain unchanged in both ST group and control group. CONCLUSIONS 10 weeks of ST improves muscle activity during the first 200 ms of contraction, maximal neural conduction, and spasticity in people with MS. However, ST does not produce adaptations in muscle contractile properties in people with MS.
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Affiliation(s)
- Luis Andreu-Caravaca
- Faculty of Sport. Catholic University of Murcia. Murcia. Spain.; International Chair of Sports Medicine. Catholic University of Murcia. Murcia. Spain..
| | - Domingo J Ramos-Campo
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF. Madrid. Spain
| | - Linda H Chung
- UCAM Research Center for High Performance. Catholic University of Murcia. Murcia. Spain
| | - Jacobo Á Rubio-Arias
- Department of Education, Health Research Center, University of Almeria, Almeria, 04120 Spain..
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Creta A, Gilio L, Centonze D, Fantozzi R. Usability of an application device for nabiximols oromucosal spray in patients with upper limb impaired multiple sclerosis. Neurodegener Dis Manag 2022; 12:195-201. [PMID: 35707977 DOI: 10.2217/nmt-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study aimed to assess the usability of a specific EU-available application device for Sativex® (USA adopted name: nabiximols) cannabinoid-based oromucosal spray in patients with multiple sclerosis (MS) and spasticity-related upper limb and hand impairment in routine daily practice. Methods: MS patients with upper limb and hand impairment evaluated the usability of the device using an ad hoc 18-item questionnaire. Results: 60 patients were included. The comprehensibility of the instructions for use, practical handling and ergonomics of the device were rated as optimal (mean scores ≥8.9/10 across questions). Assisting trained nurses also rated the device as easy to use and helpful for drug administration (mean scores 10/10). Conclusion: The application device may assist MS patients with upper limb impairment self-administer nabiximols oromucosal spray.
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Affiliation(s)
| | - Luana Gilio
- Unit of Neurology, IRCCS Neuromed, Pozzilli, Italy
| | - Diego Centonze
- Unit of Neurology, IRCCS Neuromed, Pozzilli, Italy.,Multiple Sclerosis Clinical & Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
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Patti F, Chisari CG, Fernández Ó, Sarroca J, Ferrer-Picón E, Hernández Vicente F, Vila Silván C. A real-world evidence study of nabiximols in multiple sclerosis patients with resistant spasticity: analysis in relation to the newly-described 'Spasticity-Plus syndrome'. Eur J Neurol 2022; 29:2744-2753. [PMID: 35590453 PMCID: PMC9539865 DOI: 10.1111/ene.15412] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022]
Abstract
Background and purpose Nabiximols is a therapeutic option for patients with multiple sclerosis (MS) spasticity whose symptoms are poorly controlled by conventional oral first‐line medications. This study aimed to assess the relationship between changes in spasticity severity (measured on the 0–10 numeric rating scale [NRS]) and the presence of associated symptoms in patients treated with nabiximols, and to investigate the presence of the newly described ‘spasticity‐plus syndrome’. Methods We analyzed real‐world data from the Italian Medicines Agency e‐Registry on 1138 patients with MS spasticity who began treatment with nabiximols. Evaluation time points were baseline, 4 weeks, and 3, 6, 12 and 18 months after treatment start. Results Common symptoms associated with MS spasticity in this cohort were pain (38.4% at baseline), sleep disturbances (32.7%), and spasms/cramps (28.5%). Pain was frequently clustered with sleep disturbances (57.2% of pain cases) and spasms/cramps (43.9%). Approximately one‐third of patients with data at all evaluation time points maintained treatment at 18 months. Nabiximols reduced the baseline mean spasticity 0–10 NRS score by 24.6% at Week 4, and by 33.9% at 18 months in treatment continuers. Nabiximols resolved a range of MS spasticity‐associated symptoms at Week 4, and after 18 months in treatment continuers. Conclusion This real‐world analysis supports the concept of a spasticity‐plus syndrome and suggests that nabiximols can favorably impact a range of spasticity‐associated symptoms.
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Affiliation(s)
- Francesco Patti
- Department "GF Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Clara Grazia Chisari
- Department "GF Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Óscar Fernández
- Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital and Department of Pharmacology, Faculty of Medicine, University of Malaga, Spain
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Chan A, Silván CV. Evidence-based management of multiple sclerosis spasticity with nabiximols oromucosal spray in clinical practice: a 10-year recap. Neurodegener Dis Manag 2022; 12:141-154. [PMID: 35377770 DOI: 10.2217/nmt-2022-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Effective symptomatic management of multiple sclerosis (MS) spasticity remains an unmet need for many patients. The second-line option nabiximols is the most widely investigated of the noninvasive antispasticity medications in this patient population. Clinical evidence accumulated with nabiximols since it was first approved in Europe in 2010 suggests that about 40% of initial responders (i.e., those with ≥20% improvement in their baseline 0-10 Numerical Rating Scale score) may expect to achieve clinically meaningful (≥30% Numerical Rating Scale response) and durable symptomatic improvement in MS spasticity. During 10 years' routine use of nabiximols, no new safety signals have emerged. Nabiximols-associated improvement in MS spasticity-related symptoms such as pain and sleep disruption suggests a need to track possible therapeutic effects beyond muscle tone control.
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Affiliation(s)
- Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Weizman Y, Tirosh O, Fuss FK, Tan AM, Rutz E. Recent State of Wearable IMU Sensors Use in People Living with Spasticity: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22051791. [PMID: 35270937 PMCID: PMC8914967 DOI: 10.3390/s22051791] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 05/02/2023]
Abstract
Spasticity is a disabling characteristic of neurological disorders, described by a velocity-dependent increase in muscle tone during passive stretch. During the last few years, many studies have been carried out to assess spasticity using wearable IMU (inertial measurements unit) sensors. This review aims to provide an updated framework of the current research on IMUs wearable sensors in people living with spasticity in recent studies published between 2017 and 2021. A total of 322 articles were screened, then finally 10 articles were selected. Results show the lack of homogenization of study procedures and missing apparatus information in some studies. Still, most studies performed adequately on measures of reporting and found that IMUs wearable data was successful in their respective purposes and goals. As IMUs estimate translational and rotational body motions, we believe there is a strong potential for these applications to estimate velocity-dependent exaggeration of stretch reflexes and spasticity-related characteristics in spasticity. This review also proposes new directions of research that should be challenged by larger study groups and could be of interest to both researchers as well as clinicians. The use of IMUs to evaluate spasticity is a promising avenue to provide an objective measurement as compared to non-instrumented traditional assessments.
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Affiliation(s)
- Yehuda Weizman
- Department of Health and Medical Sciences, School of Health Sciences, Hawthorn Campus, Swinburne University of Technology, Melbourne 3122, Australia; (O.T.); (A.M.T.)
- Correspondence: ; Tel.: +61-3921-45320
| | - Oren Tirosh
- Department of Health and Medical Sciences, School of Health Sciences, Hawthorn Campus, Swinburne University of Technology, Melbourne 3122, Australia; (O.T.); (A.M.T.)
| | - Franz Konstantin Fuss
- Chair of Biomechanics, Faculty of Engineering Science, University of Bayreuth, D-95440 Bayreuth, Germany;
| | - Adin Ming Tan
- Department of Health and Medical Sciences, School of Health Sciences, Hawthorn Campus, Swinburne University of Technology, Melbourne 3122, Australia; (O.T.); (A.M.T.)
| | - Erich Rutz
- Department of Orthopaedics, The Royal Children’s Hospital, Melbourne 3052, Australia;
- Murdoch Children’s Research Institute, MCRI, Parkville, Melbourne 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne 3052, Australia
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
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Abadi Marand L, Noorizadeh Dehkordi S, Roohi-Azizi M, Dadgoo M. Effect of dynamic neuromuscular stabilization on balance and trunk function in people with multiple sclerosis: protocol for a randomized control trial. Trials 2022; 23:69. [PMID: 35063011 PMCID: PMC8778496 DOI: 10.1186/s13063-022-06015-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 01/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background Multiple sclerosis is a chronic and disabling neurological disease among young people. One of the major complaints in patients with multiple sclerosis (PWMS) is falling. There are a number of factors that risk factors for falling, including balance disorder and spasticity. Core stability (CS) exercises such as trunk muscle strengthening exercises can improve balance and mobility and reduce falling. Dynamic neuromuscular stabilization (DNS) exercise is a new functional rehabilitation strategy that optimizes motor function based on the principles of developmental kinesiology. This trial will evaluate the effectiveness of DNS in comparison to CS on balance, spasticity, and falling in PWMS. Methods A total of 64 PWMS, between 30 and 50 years old and expanded disability status scale (EDSS) between 2 to 5, will be recruited from neurophysiotherapy clinic, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences to participate in this 2-armed parallel study. Participants will be randomly divided into two groups to receive CS exercise or DNS exercise. All participants will receive exercise treatment for 15 sessions during a period of 5 weeks (3 sessions per week). Primary outcome measures will be balance. Falling rate, fear of falling, patient mobility, as well as spasticity, will be measured as secondary outcomes. All outcome measures will be measured at baseline, the day after the completion of the 15th session, and after 17 weeks. Discussion Dynamic neurostabilization exercises utilize the subconscious stimulation of special zones to reflexively mediate the diaphragm and other core stabilization muscles, which is extremely effective for individuals with reduced somatosensory or movement awareness. Findings from the proposed study are expected to benefit the knowledge base of the physiotherapist, and it can be a good alternative for the rehabilitation program and even reduce medication use in patients with multiple sclerosis. These exercises are easy to understand and applicable for these patients and their partners as well. Trial registration The trial was registered in the Iran registry organization with code IRCT20140222016680N5 and was approved on April 7th, 2020. Address: IRCT administration team, Central Library Building, Iran University Campus, Hemmat Freeway, next to Milad tower, Tehran, Iran. postal code:14496-14535.
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Miller BJ, Kolobe TH, Larson RD, Pribble BA, Pardo G, James SA. Functional intermuscular reduction in spasticity for people with multiple sclerosis. Mult Scler J Exp Transl Clin 2022; 8:20552173211061547. [PMID: 35024159 PMCID: PMC8743971 DOI: 10.1177/20552173211061547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022] Open
Abstract
Background Eighty-five percent of people with multiple sclerosis (MS) incur gait impairments debilitating enough to significantly impact their function. Objectives The aim of this study was to determine if a novel combination of intermuscular electrical stimulation, followed by functional electrical stimulation combined with supported bodyweight treadmill training, would improve gait, decrease spasticity and fatigue, and improve muscle strength. Methods Using a pre-post experimental design, we implemented this combination six-week protocol in 16 individuals with MS. We completed summary statistics and longitudinal pre-post results using Wilcoxon sign rank tests with Bonferroni adjustment. Results Participants responded with median increases of 29.4 feet (p < 0.0001) during the Six Minute Walk Test, median decreases of 0.7 s (p = 0.0011) in the 25-Foot Walk Test, median increases of 3.8 toe taps to fatigue (p = 0.0306) and median increases of 5.0 heel raises (p = 0.0093). Significant changes were noted in the Modified Ashworth Scale, both after intermuscular electrical stimulation (median change = −0.5 p = 0.0039) and after treadmill walking (median change = −0.5, p < 0.0005). Conclusions Results of this novel protocol suggest this intervention combination has the potential to decrease spasticity, and improve gait speed and endurance in individuals with MS. Observed changes in mobility occurred without accompanying increases in fatigue.
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Affiliation(s)
- Bobbette J Miller
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Thubi Ha Kolobe
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | - Brian A Pribble
- Department of Health and Exercise Science, University of Oklahoma, Norman, Oklahoma, USA
| | - Gabriel Pardo
- Oklahoma Medical Research Foundation, Multiple Sclerosis Center of Excellence, Oklahoma City, Oklahoma, USA
| | - Shirley A James
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Conte A, Vila Silván C. Review of available data for the efficacy and effectiveness of nabiximols oromucosal spray (Sativex) in multiple sclerosis patients with moderate to severe spasticity. NEURODEGENER DIS 2021; 21:55-62. [PMID: 34731865 DOI: 10.1159/000520560] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sativex (USAN: nabiximols) oromucosal spray is indicated for treatment of multiple sclerosis (MS) patients with moderate to severe spasticity and inadequate response to other antispasticity medications who demonstrate clinically significant improvement during an initial trial of therapy. This narrative review investigated the efficacy and effectiveness of nabiximols oromucosal spray for moderate to severe MS spasticity by examining spasticity 010 Numerical Rating Scale (NRS) data from interventional and observational studies which featured a 4-week trial period as per the European Union approved label. SUMMARY Across both study types, clinically relevant and statistically significant reductions in mean MS spasticity 0-10 NRS scores were measured soon after treatment start and were maintained in the mid to long term in treatment responders. Initial responder rates (≥ 20% NRS improvement from baseline at week 4) ranged from 47.6% to 81.4%, tending lower in the randomized clinical trials setting. Clinically relevant responder rates (≥ 30% NRS improvement from baseline at week 12) were similar between study types (range 3041%) except for one outlier (74% in an observational study). Two open studies reported treatment continuation for ≥ 18 months in approximately half of patients who initiated treatment. In most longer-term studies, symptomatic improvement in MS spasticity was maintained at mean daily dosages of about 67 sprays/day. Safety was consistent with the known profile of nabiximols. Key messages: Experimental and observational studies of nabiximols oromucosal spray recorded similar findings. About half to two-thirds of MS patients who begin treatment will perceive initial symptomatic relief of spasticity within the 4-week trial period. About 40% of patients who initiate treatment will reach the ≥ 30% NRS improvement threshold at 3 months, comprising the majority of patients who continue long-term treatment. A trial of therapy with nabiximols is useful to identify patients most likely to gain longer-term improvement in spasticity symptoms and discontinue those with insufficient benefit.
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Affiliation(s)
- Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed Pozzilli, Pozzilli, Italy
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15
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D'hooghe M, Willekens B, Delvaux V, D'haeseleer M, Guillaume D, Laureys G, Nagels G, Vanderdonckt P, Van Pesch V, Popescu V. Sativex® (nabiximols) cannabinoid oromucosal spray in patients with resistant multiple sclerosis spasticity: the Belgian experience. BMC Neurol 2021; 21:227. [PMID: 34157999 PMCID: PMC8218396 DOI: 10.1186/s12883-021-02246-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/14/2021] [Indexed: 11/26/2022] Open
Abstract
Background This retrospective study evaluates patient-reported outcomes in patients with multiple sclerosis (MS) spasticity who were treated with a cannabinoid oromucosal spray (Sativex®, USAN name: nabiximols) after not sufficiently responding to previous anti-spasticity medications. Methods Of 276 patients from eight centers in Belgium who began treatment prior to 31 December 2017, effectiveness assessment data were available for 238 patients during the test period of 4 to 8/12 weeks, and for smaller patient cohorts with continued treatment for 6/12 months. Results Mean 0–10 spasticity Numerical Rating Scale (NRS) scores improved from 8.1 at baseline to 5.2 (week 4), 4.6 (week 8) and 4.1 (week 12). Mean EuroQoL Visual Analogue Scale (EQ VAS) scores increased from 39 at baseline to 52 (week 4), 57 (week 8) and 59 (week 12). Mean NRS and EQ VAS scores remained in the same 12 weeks’ range in patients with longer-term data. The average dose of cannabinoid oromucosal spray was 6 sprays/day. Most of the 93 out of 276 patients, with initial prescription (33.7%), who discontinued treatment by week 12 did so within the first 8 weeks, mainly due to lack of effectiveness. By week 12, 171 (74%) of the 230 effectiveness evaluable patients reported a clinically meaningful response, corresponding to ≥30% NRS improvement. The tolerability of cannabinoid oromucosal spray was consistent with its known safety profile. Conclusions More than 60% of the patients with MS who started add-on treatment with cannabinoid oromucosal spray reported a clinically relevant symptomatic effect and continued treatment after 12 weeks. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02246-0.
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Affiliation(s)
- Marie D'hooghe
- National MS Center, Vanheylenstraat 16, 1820, Melsbroek, Belgium. .,Vrije Universiteit Brussel (VUB), Center for Neurosciences, Laarbeeklaan 103, 1090, Brussel, Belgium.
| | - Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium.,University of Antwerp, Translational Neurosciences Research Group and Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | | | | | - Daniel Guillaume
- CHU Liège - Centre Neurologique et de réadaptation fonctionelle (CNRF), Liège, Belgium
| | | | - Guy Nagels
- National MS Center, Vanheylenstraat 16, 1820, Melsbroek, Belgium
| | | | | | - Veronica Popescu
- University MS Centre, Noorderhart Hospital, Maesensveld 1, 3900, Pelt, Belgium.,University MS Center, U Hasselt, Noorderhart Hospital, Martelarenlaan 42, 3500, Hasselt, Belgium
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Motamedzadeh O, Ansari NN, Naghdi S, Azimi A, Mahmoudzadeh A, Calvo S, Herrero P. A Study on the Effects of Dry Needling in Multiple Sclerosis Patients with Spasticity: Protocol of a Randomized Waitlist-Controlled Trial. J Acupunct Meridian Stud 2021; 14:82-88. [DOI: 10.51507/j.jams.2021.14.2.82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/01/2021] [Accepted: 03/08/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Omid Motamedzadeh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirreza Azimi
- MS Research Center, Neurosciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashraf Mahmoudzadeh
- Musculoskeletal Research Center, Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sandra Calvo
- iPhysio Research Group, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Pablo Herrero
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
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Sartori A, Dinoto A, Stragapede L, Mazzon G, Morelli ME, Pasquin F, Bratina A, Bosco A, Manganotti P. Nabiximols and botulinum toxin injections for patients with multiple sclerosis: efficacy on spasticity and spasms in a single-centre experience. Neurol Sci 2021; 42:5037-5043. [PMID: 33742336 DOI: 10.1007/s10072-021-05182-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/13/2021] [Indexed: 11/30/2022]
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.
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Affiliation(s)
- Arianna Sartori
- 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.
| | - Alessandro Dinoto
- 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
| | - Lara Stragapede
- 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
| | - Giulia Mazzon
- 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
| | - Maria Elisa Morelli
- 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
| | - Fulvio Pasquin
- 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
| | - Alessio Bratina
- 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
| | - Antonio Bosco
- 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
| | - Paolo Manganotti
- 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
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18
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Paul F, Silván CV. Effect of nabiximols on Goal Attainment Scale scores in patients with treatment-resistant multiple sclerosis spasticity. Neurodegener Dis Manag 2021; 11:143-153. [PMID: 33641348 DOI: 10.2217/nmt-2020-0060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: Nabiximols oromucosal spray (Sativex®) is an approved add-on treatment option for moderate-to-severe treatment-resistant multiple sclerosis (MS) spasticity. Materials & methods: This prospective, observational, noninterventional, 3-month follow-up pilot study assessed the evolution of patient-selected goal attainment scale (GAS) item scores and of MS spasticity and associated symptoms during nabiximols treatment. Results: In the full analysis set (n = 21), the mean (SD) overall unweighted GAS score increased from 32.1 (3.4) at baseline to 43.6 (14.6) at month 3 (p = 0.0060), constituting a clinically meaningful change. Slight improvements were observed in MS spasticity and most associated symptoms. Nabiximols improved walking ability and was well tolerated. Conclusion: The study provides proof-of-concept that GAS methodology can be applied to MS management in daily practice.
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Affiliation(s)
- Friedemann Paul
- Experimental & Clinical Research Center & NeuroCure Clinical Research Center, Max Delbrueck Center for Molecular Medicine & Charité-Universitätsmedizin Berlin, Berlin, Germany
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Santamato A, Facciorusso S, Spina S, Cinone N, Avvantaggiato C, Santoro L, Ciritella C, Smania N, Picelli A, Gasperini G, Molteni F, Baricich A, Fiore P. Discontinuation of botulinum neurotoxin type-A treatment during COVID-19 pandemic: an Italian survey in post stroke and traumatic brain injury patients living with spasticity. Eur J Phys Rehabil Med 2020; 57:424-433. [PMID: 33263248 DOI: 10.23736/s1973-9087.20.06478-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The COVID-19 pandemic has affected health-care systems worldwide, including the outpatient spasticity care with botulinum neurotoxin toxin type A (BoNT-A). AIM The aim of this study was to investigate the impact of discontinuation of BoNT-A treatment on patients living with spasticity during the COVID-19 quarantine. DESIGN A multicentric cross-sectional study. SETTING Outpatients setting. POPULATION Patients with spasticity after stroke and traumatic brain injury treated with BoNT-A. METHODS A phone-based survey was conducted from March to May, 2020. Based on the International Classification of Functioning, Disability and Health (ICF), an ad hoc questionnaire CORTOX (CORonavirus TOXin survey) was developed to investigate patients' experiences following the discontinuation of their usual treatment for spasticity due to the lockdown and its implication on their health perception. It assessed patients' condition and explored different ICF domains related to spasticity: unpleasant sensations, mobility, self-care, facilitators and psychosocial factors. The sum of those represented the CORTOX score (Max 142). The questionnaire also collected data about the impact of COVID-19 on patients' wellbeing (mood, sleep, relationships, community life, motivation). RESULTS A total of 151 participants completed the survey. Most participants (72.2%) experienced a worsening in perceived spasticity, 53% got worse in independence and 70.9% had a negative impact on quality of life. The mean CORTOX score was 52.85±27.25, reflecting a perceived worsening in all ICF domains investigated. Moderate to strong correlations were found between different sub-scores of the questionnaire and severity of spasticity (P<0.001). COVID-19 psychosocial related factors were associated with loss of independence (P<0.05) but only mood was associated with worsening of spasticity (P<0.001). The lack of rehabilitation therapy was significantly associated with the worsening of independence but not with the worsening of spasticity. Finally, respondents reported that BoNT-A was useful to their condition and should not be discontinued. CONCLUSIONS The discontinuation of BoNT-A treatment was associated with worsening of activities and participation and perceived spasticity. COVID-19 related problems and rehabilitation showed an association with loss of independence. CLINICAL REHABILITATION IMPACT This study will provide useful information in the field of spasticity management using a patient's centred approach, with consistent quantitative and qualitative information.
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Affiliation(s)
- Andrea Santamato
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy - .,"Fondazione Turati", Rehabilitation Center, Vieste, Foggia, Italy -
| | - Salvatore Facciorusso
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Stefania Spina
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Nicoletta Cinone
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Christian Avvantaggiato
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Luigi Santoro
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Chiara Ciritella
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Nicola Smania
- Department of Neurosciences, Neuromotor and Cognitive Rehabilitation Research Center, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Neuromotor and Cognitive Rehabilitation Research Center, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giulio Gasperini
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Alessio Baricich
- Physical Medicine and Rehabilitation Unit, Maggiore della Carità University Hospital, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Pietro Fiore
- Neurorehabilitation Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Institute of Bari, Bari, Italy
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Pashazadeh Kan F, Hoseinipalangi Z, Ahmadi N, Hosseinifard H, Dehnad A, Sadat Hoseini B, Tohidi Asl M, Ghashghaee A. Global, regional and national quality of life in patients with multiple sclerosis: a global systematic review and meta-analysis. BMJ Support Palliat Care 2020; 12:158-166. [DOI: 10.1136/bmjspcare-2020-002604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 12/26/2022]
Abstract
Background and aimThe purpose of this study was to evaluate the health-related quality of life (HRQOL) of patients with multiple sclerosis (MS) globally to provide precise information for policy makers to take necessary steps to improve the quality of life of these patients. This systematic review and meta-analysis is the first global study in the last decade.Materials and methodsData from January 2000 to April 2020 were collected from Scopus, PubMed, Embase, Web of Science and Google Scholar databases on the basis of inclusion and exclusion criteria. Data obtained were analysed by R software, and 54 articles were finally included in the study.ResultsFrom the 2126 articles collected, a total of 54 articles were included in the study. Based on the results of random-effects analysis (DerSimonian and Laird), the mental HRQOL score was 55.18 (95% CI 52.71 to 57.65) and the physical HRQOL score was 48.72 (95% CI 45.93 to 51.52). In this study, age and duration of disease had a significant and direct relationship with mental HRQOL (p≤0.01). Moreover, mental HRQOL was higher in Europe than in other continents, while physical HRQOL was higher in Asia than in other continents. HRQOL was also evaluated on the basis of three valid questionnaires: Short Form 36, Multiple Sclerosis Quality of Life-54 and Multiple Sclerosis International Quality of Life.ConclusionAccording to the results of this study, the total score for HRQOL indicates moderate quality of life. Factors such as depression, age and duration of disease have the greatest impact on HRQOL, whereas factors such as fatigue and the Expanded Disability Status Scale score have less effects on HRQOL, so that patients with MS continue their daily activities as long as they are physically able to, and this happens despite disease progression.
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21
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Abbatemarco JR, Griffin A, Jones NG, Hartman J, McKee K, Wang Z, Nagel SJ, Machado AG, Bethoux F. Long-term outcomes of intrathecal baclofen in ambulatory multiple sclerosis patients: A single-center experience. Mult Scler 2020; 27:933-941. [PMID: 32662728 DOI: 10.1177/1352458520936912] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intrathecal baclofen (ITB) is traditionally reserved for non-ambulatory patients. OBJECTIVE To investigate outcomes of ITB in ambulatory multiple sclerosis (MS) patients. METHODS Changes in outcome measures were estimated by a mixed effect model, while the complication rate was calculated using a logistic regression. Predictors of non-ambulatory status were identified by Cox model. RESULTS In all, 256 patients received an ITB test injection and 170 underwent ITB surgery. Aggregate Modified Ashworth Scale (MAS) scores for the ambulatory ITB cohort decreased from 13.5 ± 6.96 to 4.54 ± 4.18 at 5 years (p < 0.001). There was no significant change in walking speed 1 year post ITB surgery (0.45 m/second ± 0.30 vs 0.38 m/second ± 0.39, p = 0.80) with 77.8% of patients remaining ambulatory which decreased to 41.7% at year 5. Longer MS disease duration (hazard ratio (HR): 1.04; 95% confidence interval (CI): 1.01-1.07; p = 0.018) and lower hip flexor strength (HR: 0.40; 95% CI: 0.27-0.57; p < 0.001) predicted non-ambulatory status after surgery. Complications were more likely in the ambulatory cohort (odds ratio (OR): 3.30, 95% CI: 2.17-5.02; p = 0.017). CONCLUSION ITB is effective for ambulatory MS patients without compromising short-term walking speed, although a higher complication rate was observed in this cohort.
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Affiliation(s)
- Justin R Abbatemarco
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Austin Griffin
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Noble G Jones
- Department of Internal Medicine, Duke University, Durham, NC, USA/Kessler Institute for Rehabilitation, Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, West Orange, NJ, USA
| | - Jennifer Hartman
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Keith McKee
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Zhini Wang
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sean J Nagel
- Department of Neurosurgery, Center for Neurological Restoration, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Andre G Machado
- Department of Neurosurgery, Center for Neurological Restoration, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Francois Bethoux
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA/Department of Physical Medicine & Rehabilitation, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Patti F, Chisari CG, Solaro C, Benedetti MD, Berra E, Bianco A, Bruno Bossio R, Buttari F, Castelli L, Cavalla P, Cerqua R, Costantino G, Gasperini C, Guareschi A, Ippolito D, Lanzillo R, Maniscalco GT, Matta M, Paolicelli D, Petrucci L, Pontecorvo S, Righini I, Russo M, Saccà F, Salamone G, Signoriello E, Spinicci G, Spitaleri D, Tavazzi E, Trotta M, Zaffaroni M, Zappia M. Effects of THC/CBD oromucosal spray on spasticity-related symptoms in people with multiple sclerosis: results from a retrospective multicenter study. Neurol Sci 2020; 41:2905-2913. [PMID: 32335779 DOI: 10.1007/s10072-020-04413-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 04/13/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The approval of 9-δ-tetrahydocannabinol (THC)+cannabidiol (CBD) oromucosal spray (Sativex®) in Italy as an add-on medication for the management of moderate to severe spasticity in multiple sclerosis (MS) has provided a new opportunity for MS patients with drug-resistant spasticity. We aimed to investigate the improvement of MS spasticity-related symptoms in a large cohort of patients with moderate to severe spasticity in daily clinical practice. MATERIALS AND METHODS MS patients with drug-resistant spasticity were recruited from 30 Italian MS centers. All patients were eligible for THC:CBD treatment according to the approved label: ≥ 18 years of age, at least moderate spasticity (MS spasticity numerical rating scale [NRS] score ≥ 4) and not responding to the common antispastic drugs. Patients were evaluated at baseline (T0) and after 4 weeks of treatment (T1) with the spasticity NRS scale and were also asked about meaningful improvements in 6 key spasticity-related symptoms. RESULTS Out of 1615 enrolled patients, 1432 reached the end of the first month trial period (T1). Of these, 1010 patients (70.5%) reached a ≥ 20% NRS score reduction compared with baseline (initial responders; IR). We found that 627 (43.8% of 1432) patients showed an improvement in at least one spasticity-related symptom (SRSr group), 543 (86.6%) of them belonging to the IR group and 84 (13.4%) to the spasticity NRS non-responders group. CONCLUSION Our study confirmed that the therapeutic benefit of cannabinoids may extend beyond spasticity, improving spasticity-related symptoms even in non-NRS responder patients.
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Affiliation(s)
- Francesco Patti
- Department "G.F. Ingrassia", section of Neurosciences, University of Catania, Catania, Italy.
| | - Clara Grazia Chisari
- Department "G.F. Ingrassia", section of Neurosciences, University of Catania, Catania, Italy
| | - Claudio Solaro
- Department of Neurology, ASL3 Genovese, and Department of Rehabilitation, ML Novarese Hospital Moncrivello, Genoa, Italy
| | - Maria Donata Benedetti
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Neurology, University of Verona, Verona, Italy
| | - Eliana Berra
- Neurorehabilitation Unit, Department of Neurology, Neurology Institute C. Mondino, Pavia, Italy
| | - Assunta Bianco
- Multiple Sclerosis Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberto Bruno Bossio
- Neurology Operating Unit and Multiple Sclerosis Center, Provincial Health Authority of Cosenza, Cosenza, Italy
| | - Fabio Buttari
- Synaptic Immunopathology Lab, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Letizia Castelli
- Neurology Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Paola Cavalla
- Department Neuroscience and Mental Health, Multiple Sclerosis Centre, Health and Science City University Hospital of Turin, Turin, Italy
| | - Raffaella Cerqua
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | | | - Claudio Gasperini
- Multiple Sclerosis Centre, San Camillo-Forlanini Hospital, Rome, Italy
| | - Angelica Guareschi
- Multiple Sclerosis Center, Medicine Department, Fidenza Hospital, Fidenza, PR, Italy
| | - Domenico Ippolito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | | | - Manuela Matta
- Neurobiology Unit, Neurologia 2, CReSM (Regional Referring Center Multiple Sclerosis), San Luigi Gonzaga University Hospital & Neuroscience Institute Cavalieri Ottolenghi (NICO), Orbassano, TO, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | | | - Simona Pontecorvo
- Multiple Sclerosis Center of Department of Neurology and Psychiatry of Sapienza, University of Rome, Rome, Italy
| | - Isabella Righini
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Margherita Russo
- Multiple Sclerosis Centre, IRCCS-Bonino Pulejo Centre, Messina, Italy
| | - Francesco Saccà
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | | | - Elisabetta Signoriello
- Department of Clinical and Experimental Medicine, Multiple Sclerosis Center, II Division of Neurology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gabriella Spinicci
- Department of Medical Sciences and Public Health, Multiple Sclerosis Center, University of Cagliari, Cagliari, Italy
| | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale, San Giuseppe Moscati, Avellino, Italy
| | - Eleonora Tavazzi
- Multiple Sclerosis Center, Unit of Motor Neurorehabilitation, IRCCS Santa Maria Nascente, Fondazione Don Gnocchi, Milan, Italy
| | - Maria Trotta
- Institute of Neurology, University "Magna Graecia", Germaneto, Catanzaro, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, ASST della Valle Olona, Gallarate Hospital, Gallarate, VA, Italy
| | - Mario Zappia
- Department "G.F. Ingrassia", section of Neurosciences, University of Catania, Catania, Italy
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Cost-Effectiveness Analysis of Cannabinoid Oromucosal Spray Use for the Management of Spasticity in Subjects with Multiple Sclerosis. Clin Drug Investig 2020; 40:319-326. [DOI: 10.1007/s40261-020-00895-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Meuth SG, Henze T, Essner U, Trompke C, Vila Silván C. Tetrahydrocannabinol and cannabidiol oromucosal spray in resistant multiple sclerosis spasticity: consistency of response across subgroups from the SAVANT randomized clinical trial. Int J Neurosci 2020; 130:1199-1205. [PMID: 32065006 DOI: 10.1080/00207454.2020.1730832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To determine whether differences in disability status, spasticity severity, and spasticity duration at treatment start in patients with resistant multiple sclerosis (MS) spasticity might influence response to add-on tetrahydrocannabinol:cannabidiol (THC:CBD) oromucosal spray (nabiximols) versus further re-adjustment of optimized first-line antispasticity medication.Methods: Using the database from the Sativex® as Add-on therapy Vs. further optimized first-line ANTispastics (SAVANT) study, this post hoc analysis evaluated spasticity severity (0-10 numerical rating scale [NRS] scores) and pain severity (0-10 NRS scores) evolution from randomization (baseline) to week 12 (end of double-blind treatment) in defined subgroups: Expanded disability status scale [EDSS] score subgroups (<6 and ≥6); spasticity severity 0-10 NRS score subgroups (4 to ≤6 and >6), and spasticity duration subgroups (<5 and ≥5 years).Results: THC:CBD oromucosal spray (nabiximols) halved mean severity scores for spasticity and pain in all subgroups. Active treatment significantly improved mean spasticity severity scores versus placebo from week 4 onwards in both EDSS subgroups, in the severe spasticity subgroup, and in both spasticity duration subgroups. Active treatment significantly improved mean pain severity scores versus placebo in the ≥6 EDSS subgroup, in the severe spasticity subgroup and in both spasticity duration subgroups.Conclusion: Add-on THC:CBD oromucosal spray (nabiximols) consistently relieves resistant spasticity across subgroups defined by baseline EDSS score, spasticity severity NRS score and spasticity duration. Patients with moderate resistant MS spasticity benefit numerically from treatment; patients with severe resistant spasticity achieve significant therapeutic gains. Spasticity-associated pain often improves similarly in the same subgroups.
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Affiliation(s)
- Sven G Meuth
- Department of Neurology with Institute of Translational Neurology, University Hospital Munster, Munster, Germany
| | | | - Ute Essner
- O. Meany Consultancy GmbH, Hamburg, Germany
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25
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Norbye AD, Midgard R, Thrane G. Spasticity, gait, and balance in patients with multiple sclerosis: A cross-sectional study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1799. [PMID: 31287210 DOI: 10.1002/pri.1799] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 04/10/2019] [Accepted: 05/17/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE More than 80% of people with multiple sclerosis (MS) are affected by spasticity. Spasticity is known to reduce quality of life and contribute to additional symptoms, such as pain and reduced mobility, but the association between spasticity, balance, and mobility has not yet been established. Our aim was to examine whether a relationship exists between spasticity in the lower limbs, balance, and gait, as well as to explore the involvement of different muscle groups. METHODS This study employed a cross-sectional design. Thirty patients with MS were included. The Modified Ashworth Scale (MAS) was used to examine spasticity in the ankle plantar flexors, knee extensors, and hip adductors. Balance was measured using the Mini-Balance Evaluation Systems Test, and gait with the 2-Minute Walk Test. The participants were tested once with no additional follow-up. Spearman's correlation, recursive partitioning, and linear regression analyses were used to explore the association. RESULTS A significant correlation between gait distance and spasticity in the ankle plantar flexors (ρ = -.69, p < .001) and knee extensors (ρ = -.45, p = .012) was observed. Balance significantly correlated with spasticity in ankle plantar flexors (ρ = -.69, p < .001), knee extensors (ρ = -.52, p = .003), and hip adductors (ρ = -.5, p = .005). The relationship between spasticity in ankle plantar flexors and hip adductors was significant, even from low levels of spasticity, whereas MAS score ≥ 2 was clinically correlated with a decrease in gait and balance function. Adjustments for sex, age, or years since diagnosis had only minor impact on the results. CONCLUSIONS This study indicates that spasticity in the lower limbs is clinically significantly associated with mobility in people with MS.
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Affiliation(s)
- Anja Davis Norbye
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Neurology, Molde Hospital, Møre and Romsdal Health Trust, Molde, Norway.,Department of Physiotherapy, University Hospital of North Norway, Tromsø, Norway
| | - Rune Midgard
- Department of Neurology, Molde Hospital, Møre and Romsdal Health Trust, Molde, Norway.,Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gyrd Thrane
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Dymecka J, Bidzan M. Biomedical Variables and Adaptation to Disease and Health-Related Quality of Life in Polish Patients with MS. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122678. [PMID: 30486508 PMCID: PMC6313333 DOI: 10.3390/ijerph15122678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 11/14/2018] [Accepted: 11/24/2018] [Indexed: 02/03/2023]
Abstract
The aim of this research was to assess the level of adaptation to multiple sclerosis (Sclerosis multiplex; MS) and health-related quality of life (HRQoL) of the study population as well as to determine the relationship between biomedical factors related to the course of multiple sclerosis, adaptation to the disease, and HRQoL. Analysis of medical records, clinical and psychological interviews, the Extended Disability Status Scale (EDSS), Guy’s Neurological Disability Scale (GNDS), the Acceptance of Illness Scale (AIS), and the Multiple Sclerosis Impact Scale 29 (MSIS-29) were collected from 137 patients with MS. It was found that there was a relation between motor impairment, neurological disability, adaptation to illness, and HRQoL; it was also found that there were negative correlations between adaptation to illness and the severity of lower-limb disability, fatigue, mood disorders, other problems related to MS, and upper-limb disability. Of all the symptoms, lower-limb disability, fatigue, and mood disorders had the strongest relation with adaptation. All of the analysed symptoms were found to correlate with HRQoL. Of all the symptoms, HRQoL was most affected by lower- and upper-limb disability, fatigue, other MS problems, and mood disorders.
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Affiliation(s)
- Joanna Dymecka
- Institute of Psychology, University of Opole, 45-052 Opole, Poland.
| | - Mariola Bidzan
- Institute of Psychology, University of Gdansk, 80-309 Gdansk, Poland.
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Arroyo González R. A review of the effects of baclofen and of THC:CBD oromucosal spray on spasticity-related walking impairment in multiple sclerosis. Expert Rev Neurother 2018; 18:785-791. [PMID: 30235965 DOI: 10.1080/14737175.2018.1510772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a complex disease with a heterogeneous and unpredictable clinical course. Mobility impairment after progressive paralyses and muscle tone spasticity is common. Areas covered: The prevalence, assessment, and pharmacological management of gait impairment and spasticity in MS and their effects on health-related quality of life (HRQoL) are discussed. The roles of oral and intrathecal baclofen and of delta-9-tetrahydrocannabinol/cannabidiol (THC:CBD) oromucosal spray in treating MS spasticity-related gait impairment are reviewed. Expert commentary: Mobility impairment and spasticity are experienced by approximately 90% and 80% of MS patients, respectively, during the disease course. Prevalence and severity of gait impairment and spasticity increase as disease progresses. The symptoms are related and both impact negatively on HRQoL. Oral baclofen and tizanidine are generally used for first-line treatment of MS spasticity but are ineffective in approximately 40% of cases. Second-line therapy includes add-on THC:CBD spray for patients with resistant MS spasticity. Results of studies evaluating baclofen for treating MS spasticity gait impairment are equivocal. In studies of patients with resistant MS spasticity, THC:CBD spray consistently improved the timed 10-meter walk test and significantly improved multiple spatial-temporal and kinematic gait parameters. THC:CBD oromucosal spray warrants further investigation as a treatment for MS spasticity-related gait impairment.
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Affiliation(s)
- Rafael Arroyo González
- a Neurology Department , Hospital Universitario Quironsalud Madrid , Pozuelo de Alarcón, Madrid , Spain
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28
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Markovà J, Essner U, Akmaz B, Marinelli M, Trompke C, Lentschat A, Vila C. Sativex® as add-on therapy vs. further optimized first-line ANTispastics (SAVANT) in resistant multiple sclerosis spasticity: a double-blind, placebo-controlled randomised clinical trial. Int J Neurosci 2018; 129:119-128. [DOI: 10.1080/00207454.2018.1481066] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Jolana Markovà
- Neurology Department, Thomayer's Hospital, Praha, Czechia
| | - Ute Essner
- O. Meany Consultancy GmbH, Hamburg, Germany
| | - Bülent Akmaz
- Market Access Manager, Almirall Hermal GmbH, Reinbek, Germany
| | | | - Christiane Trompke
- International Clinical Trial Managers, Almirall Hermal GmbH, Reinbek, Germany
| | - Arnd Lentschat
- International Clinical Trial Managers, Almirall Hermal GmbH, Reinbek, Germany
| | - Carlos Vila
- Neurology Medical Manager, Global Medical Affairs, Almirall S.A., Barcelona, Spain
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29
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Barin L, Salmen A, Disanto G, Babačić H, Calabrese P, Chan A, Kamm CP, Kesselring J, Kuhle J, Gobbi C, Pot C, Puhan MA, von Wyl V. The disease burden of Multiple Sclerosis from the individual and population perspective: Which symptoms matter most? Mult Scler Relat Disord 2018; 25:112-121. [PMID: 30059895 DOI: 10.1016/j.msard.2018.07.013] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/22/2018] [Accepted: 07/08/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND MS symptoms affect many functional domains. Knowing the specific impact of symptoms on health-related quality of life (HRQoL) is vital for successful disease and symptom management in MS. We aimed at investigating how specific MS symptoms contribute to the disease burden in individuals and from a population perspective. METHODS We included 855 Swiss Multiple Sclerosis Registry participants with a relapsing-remitting form (RRMS) or a progressive form (PMS). HRQoL was measured with the EuroQol 5-Dimension EQ-5D-index and EQ-Visual Analogue Scale (EQ-VAS) on 0-100% scales. Their associations with 20 symptoms, socio-demographic and clinical information were explored in median regression models, stratified by RRMS and PMS. RESULTS We included 611 participants with RRMS and 244 with PMS. In RRMS, gait (-6.5%) and balance problems (-5.1%) had the largest EQ-5D-index reductions, and were also important at the population level (frequencies 45% and 52%). Fatigue, depression, and spasticity (frequencies 74.1%, 31%, 38%) also contributed to the population disease burden. In PMS, spasticity, paralysis, and bowel problems had the largest impact on EQ-5D-index, both at the individual and population levels. The largest impact on EQ-VAS at population level was associated in RRMS with balance problems, depression, dizziness, and spasticity, while in PMS with weakness, pain, and paralysis. CONCLUSIONS While HRQoL at population level is most affected by balance problems, spasticity, and depression in RRMS, the biggest HRQoL losses in PMS are caused by spasticity, paralysis, weakness, and pain. Many symptoms with the largest effects in individuals substantially contribute to the population disease burden.
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Affiliation(s)
- Laura Barin
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Anke Salmen
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland.
| | - Giulio Disanto
- Neurocenter of southern Switzerland, Ospedale regionale di Lugano, Lugano, Switzerland; Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Haris Babačić
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Pasquale Calabrese
- Neuropsychology and Behavioral Neurology Unit, Division of Molecular and Cognitive Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland.
| | - Andrew Chan
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland.
| | - Christian P Kamm
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland; Neurology and Neurorehabilitation Centre, Luzerner Kantonsspital, Lucerne, Switzerland.
| | - Jürg Kesselring
- Department of Neurology & Neurorehabilitation, Rehabilitation Centre Kliniken Valens, Valens, Switzerland.
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Claudio Gobbi
- Neurocenter of southern Switzerland, Ospedale regionale di Lugano, Lugano, Switzerland.
| | - Caroline Pot
- Laboratories of Neuroimmunology, Division of Neurology and Neuroscience Research Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland.
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
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Mallada Frechín J. Effect of tetrahydrocannabinol:cannabidiol oromucosal spray on activities of daily living in multiple sclerosis patients with resistant spasticity: a retrospective, observational study. Neurodegener Dis Manag 2018; 8:151-159. [DOI: 10.2217/nmt-2017-0055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To examine evolution in activities of daily living (ADL) in patients with multiple sclerosis spasticity during long-term use of tetrahydrocannabinol (THC):cannabidiol (CBD) oromucosal spray. Methods: Functional impairment was assessed retrospectively (prior to start of treatment) and at the present moment using a 16-item ADL survey; results were compared. A control group without add-on THC:CBD oromucosal spray was included to investigate possible recall bias. Results: ADL was maintained or slightly improved with THC:CBD oromucosal spray across treatment time (mean 31.9 months) including significant improvement in ‘standing up’ (p < 0.05) and trends in other items. Significant improvements (p < 0.01) with THC:CBD oromucosal spray were observed in several multiple sclerosis spasticity-related symptoms. Overall, 96.9% of patients using THC:CBD oromucosal spray had a positive global impression of change during treatment. Conclusion: In this pilot study, THC:CBD oromucosal spray maintained or improved aspects of daily functioning. Further study in a larger trial is warranted.
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31
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Lus G, Cantello R, Danni MC, Rini A, Sarchielli P, Tassinari T, Signoriello E. Palatability and oral cavity tolerability of THC:CBD oromucosal spray and possible improvement measures in multiple sclerosis patients with resistant spasticity: a pilot study. Neurodegener Dis Manag 2018; 8:105-113. [DOI: 10.2217/nmt-2017-0056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aim: Complaints about Δ9-tetrahydrocannabinol (THC):cannabidiol (CBD) oromucosal spray (Sativex®; GW Pharma Ltd, Salisbury, UK) in the management of multiple sclerosis spasticity include unpleasant taste and oral mucosal anomalies. This pilot study assessed the use of sugar-free chewing gum and/or a refrigerated bottle of THC:CBD oromucosal spray to mitigate these effects. Materials & methods: Patients with multiple sclerosis spasticity (n = 52) at six sites in Italy who were receiving THC:CBD oromucosal spray and had associated oral mucosal effects were randomized into Group A (chewing gum; n = 15); Group B (cold bottle; n = 20); and Group C (cold bottle + chewing gum; n = 17). Results: Taste perception in patients receiving chewing gum ± cold bottle intervention (Groups A and C combined) was significantly (p = 0.0001) improved from baseline to week 4 while maintaining spasticity control. Conclusion: Patient comfort, satisfaction and treatment adherence may benefit from these interventions.
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Affiliation(s)
- Giacomo Lus
- Multiple Sclerosis Center, II Division of Neurology, Department of Clinical & Experimental Medicine, Second University of Naples, Naples, Italy
| | - Roberto Cantello
- Department of Neurology, University of Eastern Piedmont, Novara, Italy
| | - Maura Chiara Danni
- Neurological Clinic, Department of Experimental & Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Agusto Rini
- Neurology Service, Ospedale A. di Summa Perrino, Brindisi, Italy
| | - Paola Sarchielli
- Dipartimento di Medicina, Clinica Neurologica, Università degli Studi di Perugia, Perugia, Italy
| | | | - Elisabetta Signoriello
- Multiple Sclerosis Center, II Division of Neurology, Department of Clinical & Experimental Medicine, Second University of Naples, Naples, Italy
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Nagel SJ, Wilson S, Johnson MD, Machado A, Frizon L, Chardon MK, Reddy CG, Gillies GT, Howard MA. Spinal Cord Stimulation for Spasticity: Historical Approaches, Current Status, and Future Directions. Neuromodulation 2017; 20:307-321. [PMID: 28370802 DOI: 10.1111/ner.12591] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/08/2016] [Accepted: 01/03/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Millions of people worldwide suffer with spasticity related to irreversible damage to the brain or spinal cord. Typical antecedent events include stroke, traumatic brain injury, and spinal cord injury, although insidious onset is also common. Regardless of the cause, the resulting spasticity leads to years of disability and reduced quality of life. Many treatments are available to manage spasticity; yet each is fraught with drawbacks including incomplete response, high cost, limited duration, dose-limiting side effects, and periodic maintenance. Spinal cord stimulation (SCS), a once promising therapy for spasticity, has largely been relegated to permanent experimental status. METHODS In this review, our goal is to document and critique the history and assess the development of SCS as a treatment of lower limb spasticity. By incorporating recent discoveries with the insights gained from the early pioneers in this field, we intend to lay the groundwork needed to propose testable hypotheses for future studies. RESULTS SCS has been tested in over 25 different conditions since a potentially beneficial effect was first reported in 1973. However, the lack of a fully formed understanding of the pathophysiology of spasticity, archaic study methodology, and the early technological limitations of implantable hardware limit the validity of many studies. SCS offers a measure of control for spasticity that cannot be duplicated with other interventions. CONCLUSIONS With improved energy-source miniaturization, tailored control algorithms, novel implant design, and a clearer picture of the pathophysiology of spasticity, we are poised to reintroduce and test SCS in this population.
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Affiliation(s)
- Sean J Nagel
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Saul Wilson
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael D Johnson
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andre Machado
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Leonardo Frizon
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Matthieu K Chardon
- Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chandan G Reddy
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - George T Gillies
- Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA
| | - Matthew A Howard
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Illomei G, Spinicci G, Locci E, Marrosu MG. Muscle elastography: a new imaging technique for multiple sclerosis spasticity measurement. Neurol Sci 2016; 38:433-439. [PMID: 27904961 DOI: 10.1007/s10072-016-2780-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/11/2016] [Indexed: 12/21/2022]
Abstract
Multiple sclerosis (MS) spasticity is currently evaluated on the basis of neurological examinations such as Ashworth Scale (AS) and 0-10 NRS. Severity of spasticity is difficult to quantify. We investigated the use of real time elastography (RTHE) ultrasounds for evaluating objectively the muscle fibers status in MS spasticity patients and their changes after a new antispasticity treatment. Two studies were performed. In study A, 110 MS patients underwent a neurological evaluation based on the AS and RTHE. The RTHE images were scored with the new 1-5 muscle fibers rigidity imaging scale, here called MEMSs (Muscle Elastography Multiple Sclerosis Score). The correlation between AS and MEMSs was found to be statistically significant. In study B, 55 MS patients treated with THC:CBD oromucosal spray for their resistant spasticity were followed prospectively. MS spasticity was evaluated by the 0-10 NRS scale at baseline and after 4 weeks of treatment. MEMSs' figures were obtained at both timepoints. Responders to THC:CBD oromucosal spray (pre-defined as an improvement ≥20% in their 0-10 NRS spasticity score vs. baseline) were 65% of sample. These patients had a mean 0-10 NRS reduction of 1.87 and a MEMSs reduction of 1.97 (P values <0.0001). The remaining 35% of patients, classified as clinically non-responders, showed still a significant mean reduction in MEMSs (0.8, P = 0.002). Our overall results showed that RTHE, operativized throughout MEMSs, could be an objective gold standard to evaluate MS muscle spasticity as well as the effectiveness of antispasticity therapy.
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Affiliation(s)
- G Illomei
- Advanced Ultrasound Center and Diagnostic Imaging "Studio Radiologico del Corso", Corso Vittorio Emanuele 69, 09124, Cagliari, Italy.
| | - G Spinicci
- Multiple Sclerosis Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - E Locci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - M G Marrosu
- Multiple Sclerosis Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Ofori J, Freeman J, Logan A, Rapson R, Zajieck J, Hobart J, Marsden J. An investigation of commonly prescribed stretches of the ankle plantarflexors in people with Multiple Sclerosis. Clin Biomech (Bristol, Avon) 2016; 37:22-26. [PMID: 27286554 DOI: 10.1016/j.clinbiomech.2016.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 04/04/2016] [Accepted: 05/18/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Stretches are often prescribed to manage increased limb stiffness in people with Multiple Sclerosis. This study determined the ankle plantarflexor torque magnitude that people with Multiple Sclerosis can apply during four commonly prescribed stretches and determined the relationship between the applied torque and functional ability. METHODS People with Multiple Sclerosis (N=27) were compared to healthy control participants (n=15). Four stretches were investigated; stretching in step standing; using a step; pulling the ankle into dorsiflexion and standing in a frame. Joint position and forces were measured using 3D motion analysis and torque transducers. Baseline ankle strength and stiffness was measured using motor driven ankle perturbations. FINDINGS People with Multiple Sclerosis (N=27) had higher stretch reflex amplitudes and lower strength compared to the control group (n=15). People with Multiple Sclerosis achieved less lengthening of the plantarflexor muscle-tendon complex when stretching but similar ankle torques compared to controls. While stretching people with Multiple Sclerosis showed greater muscle activation in the ankle plantarflexors. Stretches in weight bearing positions produced higher plantarflexor torques. People with Multiple Sclerosis with lower functional ability preferred the more supported stretches (ankle pull and standing frame). INTERPRETATION Stretches in weight bearing positions achieve higher ankle torques but this is in part due to increased postural activity in people with Multiple Sclerosis. Functional ability may limit stretch effectiveness.
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Affiliation(s)
- J Ofori
- School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, PL6 8BH, UK
| | - J Freeman
- School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, PL6 8BH, UK
| | - A Logan
- Stroke Rehabilitation Unit, Camborne/Redruth Community Hospital, Barncoose Terrace, Redruth TR15 3ER, UK
| | - R Rapson
- Paediatrics and Learning Disabilities, South Devon Healthcare NHS Foundation Trust, Bidwell Brook School, Shinners Bridge, Dartington, TQ9 6JU, UK
| | - J Zajieck
- Peninsula College of Medicine and Dentistry University of Plymouth, PL6 8BH, UK
| | - J Hobart
- Peninsula College of Medicine and Dentistry University of Plymouth, PL6 8BH, UK
| | - J Marsden
- School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, PL6 8BH, UK.
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Vidal J, Slof J, Serrano D, Marqués T, Kumru H, Benito-Penalva J. Cost-effectiveness of Intrathecal Baclofen Therapy in severe refractory non-focal disabling spasticity: a Spanish hospital perspective. Expert Rev Pharmacoecon Outcomes Res 2016; 17:67-76. [PMID: 27142176 DOI: 10.1080/14737167.2016.1180247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Current knowledge about long-term economic consequences of Intrathecal Baclofen Therapy (ITB Therapy®) is incomplete. METHODS A markov model was developed to estimate long-term clinical and economic outcomes with ITB Therapy® and conventional medical management of severe refractory non-focal disabling spasticity. Clinical and cost inputs were obtained through a non-interventional, prospective, observational study in a Spanish neurorehabilitation hospital. RESULTS ITB Therapy® increased remaining lifetime costs by €35,605 and resulted in a gain of 1.06 quality-adjusted life-years (QALYs), thus showing an incremental cost-effectiveness ratio (ICER) of €33,619/QALY gained. In alternative scenarios, reflecting other clinical settings and management options, considerably lower ICER values were obtained. In particular, opportunities were identified to improve efficiency by setting clinically and economically sound targets for post-operation length of stay. CONCLUSION In the Spanish setting, ITB Therapy® resulted in an ICER close to €30,000/QALY gained; potential ways to reduce costs and further enhance efficiency can be identified.
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Affiliation(s)
- Joan Vidal
- a Fundació Institut Guttmann , Institut Universitari de Neurorehabilitació adscrit a la UAB , Badalona , Spain
| | - John Slof
- b Universitat Autònoma de Barcelona , Bellaterra , Spain
| | - David Serrano
- c Autonomous Consultant , Barberá del Vallés , Spain
| | - Teresa Marqués
- a Fundació Institut Guttmann , Institut Universitari de Neurorehabilitació adscrit a la UAB , Badalona , Spain
| | - Hatice Kumru
- a Fundació Institut Guttmann , Institut Universitari de Neurorehabilitació adscrit a la UAB , Badalona , Spain
| | - Jesús Benito-Penalva
- a Fundació Institut Guttmann , Institut Universitari de Neurorehabilitació adscrit a la UAB , Badalona , Spain
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Milinis K, Tennant A, Young C. Spasticity in multiple sclerosis: Associations with impairments and overall quality of life. Mult Scler Relat Disord 2016; 5:34-9. [DOI: 10.1016/j.msard.2015.10.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 10/06/2015] [Accepted: 10/20/2015] [Indexed: 02/04/2023]
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Milinis K, Young CA. Systematic review of the influence of spasticity on quality of life in adults with chronic neurological conditions. Disabil Rehabil 2015; 38:1431-1441. [DOI: 10.3109/09638288.2015.1106592] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Tintoré M. Advances in the management of multiple sclerosis symptoms: pathophysiology and assessment of spasticity in multiple sclerosis. Neurodegener Dis Manag 2015; 5:15-7. [DOI: 10.2217/nmt.15.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Spasticity is a prevalent and troublesome symptom for people with multiple sclerosis (MS). Common instruments to measure MS spasticity include the clinician-rated (modified) Ashworth scale and the patient-rated 0–10 spasticity Numerical Rating Scale (NRS). Current opinion is that measurement of MS spasticity should incorporate the patient's perspective. Other instruments to assess spasticity-associated symptoms such as the Penn spasms frequency scale, sleep quality NRS and pain NRS can assist in tracking MS spasticity evolution and inform management choices. Worsening spasticity reduces patient autonomy, impacts negatively on quality of life and increases health resource utilization and costs. Despite the wide range of issues associated with MS spasticity, undertreatment is common and standard treatment options (physiotherapy and classical oral therapies) often fail to provide adequate symptomatic control.
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Affiliation(s)
- Mar Tintoré
- Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Ps. Vall d'Hebron, 119–129, 08035 Barcelona, Spain
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Meca-Lallana JE, Hernández-Clares R, Carreón-Guarnizo E. Spasticity in multiple sclerosis and role of glatiramer acetate treatment. Brain Behav 2015; 5:e00367. [PMID: 26445705 PMCID: PMC4589813 DOI: 10.1002/brb3.367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/28/2015] [Accepted: 06/07/2015] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Spasticity is one of the most disabling and difficult-to-treat symptoms shown by patients with multiple sclerosis, who often show a suboptimal and unsatisfactory response to classic treatment and new available nonpharmacological alternatives. Due to the progressive nature of this condition, the early management should be essential to improve long-term outcomes. METHODS We performed a narrative literature review of the contribution of spasticity to the burden of multiple sclerosis and the potential role of classic disease-modifying drugs. RESULTS Added to the underlying pathophysiology of spasticity, certain external factors and drugs such as interferon may exacerbate the existing condition, hence their awareness is crucial as part of an effective management of spasticity. Furthermore, the evidence for the effectiveness of glatiramer acetate in preventing spasticity in naïve patients and in those switching from interferon should not be ignored. CONCLUSIONS This literature review proposes the examination of spasticity and the influence of classic disease-modifying agents on the level of existing condition among the variables to be considered when deciding on therapy for multiple sclerosis in clinical practice.
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Affiliation(s)
- Jose Eustasio Meca-Lallana
- Department of Neurology, Multiple Sclerosis Unit, Hospital Clínico Universitario Virgen de la Arrixaca Carretera Madrid-Cartagena s/n, 30120, Murcia, Spain ; Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, UCAM Universidad Católica San Antonio de Murcia Campus de los Jerónimos, Guadalupe, 30107, Murcia, Spain
| | - Rocío Hernández-Clares
- Department of Neurology, Multiple Sclerosis Unit, Hospital Clínico Universitario Virgen de la Arrixaca Carretera Madrid-Cartagena s/n, 30120, Murcia, Spain ; Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, UCAM Universidad Católica San Antonio de Murcia Campus de los Jerónimos, Guadalupe, 30107, Murcia, Spain
| | - Ester Carreón-Guarnizo
- Department of Neurology, Multiple Sclerosis Unit, Hospital Clínico Universitario Virgen de la Arrixaca Carretera Madrid-Cartagena s/n, 30120, Murcia, Spain ; Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, UCAM Universidad Católica San Antonio de Murcia Campus de los Jerónimos, Guadalupe, 30107, Murcia, Spain
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Vermersch P. MObility ImproVEment with spasticity in multiple sclerosis in Europe: the MOVE 1 EU study. Neurodegener Dis Manag 2015; 4:407-15. [PMID: 25531685 DOI: 10.2217/nmt.14.44] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM using a protocol similar to that of the MOVE 1 study in Germany, the multicenter, observational MOVE 1 EU study examined the burden of multiple sclerosis (MS)-related spasticity in other EU countries (Belgium, Finland, France, Ireland, Norway, Poland and Portugal). MATERIALS & METHODS A 12-month retrospective chart documentation was combined with questionnaires for physicians and patients at the time of enrollment. A total of 281 patients from neurology departments and MS units formed the per protocol population. RESULTS in most patients, MS spasticity frequently restricted daily activities and caused some/moderate problems in EQ-5D subdomains of mobility, usual activities and pain/discomfort. Overall, 48% of physicians and 34% of patients were at least partly dissatisfied with the effectiveness of available pharmacotherapy options for MS spasticity. CONCLUSION Results of the MOVE 1 Germany and MOVE 1 EU studies are aligned and highlight the need to optimize the therapeutic management of patients with MS spasticity across Europe so as to improve their overall well-being and quality of life.
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Arroyo R, Vila C, Dechant KL. Impact of Sativex(®) on quality of life and activities of daily living in patients with multiple sclerosis spasticity. J Comp Eff Res 2015; 3:435-44. [PMID: 25275238 DOI: 10.2217/cer.14.30] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In individuals with multiple sclerosis (MS) spasticity, associated symptoms such as spasms, pain, mobility restrictions and sleep disturbances can interfere with the ability to perform activities of daily living and reduce quality of life (QoL). Recent cross-sectional studies from Europe have confirmed that advancing severity of MS spasticity correlates directly with worsening QoL. The treatment effect of Sativex(®) (GW Pharmaceuticals PLC, Porton Down, UK; Laboratorios Almirall, SA, Barcelona, Spain) on QoL has been evaluated in randomized controlled trials, observational studies conducted under everyday clinical practice conditions and a survey in long-term users. Symptomatic relief of MS spasticity in responders to Sativex was associated with quantifiable improvements in QoL and activities of daily living that were maintained over time. Benefits were perceived by both patients and caregivers.
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Affiliation(s)
- Rafael Arroyo
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
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Meuth SG, Vila C, Dechant KL. Effect of Sativex on spasticity-associated symptoms in patients with multiple sclerosis. Expert Rev Neurother 2015; 15:909-18. [DOI: 10.1586/14737175.2015.1067607] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Slof J, Ruiz L, Vila C. Cost-effectiveness of Sativex in multiple sclerosis spasticity: new data and application to Italy. Expert Rev Pharmacoecon Outcomes Res 2015; 15:379-91. [PMID: 25771713 DOI: 10.1586/14737167.2015.1025759] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Multiple sclerosis (MS) is a chronic progressive disease that carries a high socioeconomic burden. Spasticity (rigidity and spasms) is common in MS and contributes to MS-related disability. This study aims to evaluate the cost-effectiveness of Sativex(®) (9-delta-tetrahydrocannabinol plus cannabidiol oromucosal spray) when used as add-on therapy for management of resistant MS-related spasticity in the context of the Italian healthcare system. A previously published Markov model-based analysis for the German and Spanish context was replicated, adapting it to the Italian setting. Model parameters were updated to reflect recent findings about MS-related spasticity and use of Sativex in daily clinical practice. The base case incremental cost-effectiveness ratio for Sativex use in Italy over a 5-year period was estimated to be €4968 per quality-adjusted life-year gained (year of costing: 2013). Sativex remained an efficient option in the Italian healthcare context - below the commonly accepted incremental threshold of €30,000 per quality-adjusted life-year gained - when deterministic and probabilistic sensitivity analyses were conducted. Sativex can be regarded as a cost-effective treatment option for patients with MS-related spasticity in Italy.
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Affiliation(s)
- John Slof
- Universitat Autònoma de Barcelona, Campus de la UAB, 08193, Bellaterra, Spain
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Zhao W, Wang C, Li Z, Chen L, Li J, Cui W, Ding S, Xi Q, Wang F, Jia F, Xiao S, Guo Y, Zhao Y. Efficacy and safety of transcutaneous electrical acupoint stimulation to treat muscle spasticity following brain injury: a double-blinded, multicenter, randomized controlled trial. PLoS One 2015; 10:e0116976. [PMID: 25643051 PMCID: PMC4314074 DOI: 10.1371/journal.pone.0116976] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 12/07/2014] [Indexed: 11/18/2022] Open
Abstract
Objective This study was aimed at evaluating the clinical efficacy and safety of transcutaneous electrical acupoint stimulation (TEAS) to treat muscle spasticity after brain injury (Chinese Clinical Trial Registry: ChiCTR-TRC-11001310). Methods A total of 60 patients with muscle spasticity after brain injury were randomized to the following 3 groups: 100, 2, and 0 Hz (sham) TEAS. The acupoints Hegu (LI4)—Yuji (LU10) and Zusanli (ST36)—Chengshan (BL57) on the injured side were stimulated at 0, 2, or 100 Hz, 5 times per week for 4 weeks. The patients were followed up for 1 and 2 months after the treatments. The effects of the treatments on muscle spasticity at the wrist, thumb, the other 4 fingers, elbow, shoulder, knee, and ankle were evaluated by the Modified Ashworth Scale, and the effects on disability were assessed by the Disability Assessment Scale. The walking capability was evaluated by the Holden functional ambulation classification score. The overall performance was assessed by the Global Assessment Scale score and the improved Barthel Index. The safety of the treatments administered was also monitored. Results The wrist spasticity was significantly reduced from baseline at weeks 2, 3, and 4 of treatment and at the 1- and 2-month follow-up visits in the 100 Hz group (P < 0.01). Compared with 2 Hz or sham TEAS, 100 Hz TEAS decreased wrist spasticity at weeks 2, 3, and 4 of treatment and 1 month after treatment (P < 0.001). The other endpoints were not affected by the treatments. No treatment-emergent adverse events were reported during treatments and follow-up visits. Conclusions TEAS appears to be a safe and effective therapy to relieve muscle spasticity after brain injury, although large-scale studies are required to further verify the findings. Trial Registration Chinese Clinical Trial Registry ChiCTR-TRC-11001310 http://www.chictr.org
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Affiliation(s)
- Wenli Zhao
- Department of Neurology, Tianjin Nankai Hospital, Tianjin, 300100, China
| | - Chao Wang
- Department of Acupuncture and Moxibustion, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Zhongzheng Li
- Department of Acupuncture and Moxibustion, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Lei Chen
- Department of Acupuncture and Moxibustion, Tianjin Ninghe Hospital, Tianjin, 301500, China
| | - Jianbo Li
- Department of Acupuncture and Moxibustion, Tianjin Ninghe Hospital, Tianjin, 301500, China
| | - Weidong Cui
- Department of Acupuncture and Moxibustion, Tianjin Ninghe Hospital, Tianjin, 301500, China
| | - Shasha Ding
- Department of Acupuncture and Moxibustion, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Qiang Xi
- Department of Acupuncture and Moxibustion, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Fan Wang
- Department of Acupuncture and Moxibustion, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Fei Jia
- Department of Acupuncture and Moxibustion, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Shuhua Xiao
- Department of Acupuncture and Moxibustion, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Yi Guo
- Department of Acupuncture and Moxibustion, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Ye Zhao
- Department of Clinical Research, Tianjin Nankai Hospital and Tianjin Academy of Integrative Medicine, Tianjin, 300100, China
- * E-mail:
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Trojano M, Celius EG, Donzé C, Izquierdo G, Patti F, Pöhlau D. Clinical Case Reviews and Poster Sessions in Multiple Sclerosis Spasticity: Main Outcomes and Highlights. Eur Neurol 2014; 72 Suppl 1:15-9. [DOI: 10.1159/000367619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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