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Boi A, Ventura L, Martinez G, Morrone M, Aiello E, Deriu F, Manca A. Isokinetic and electromyographic characterization of ankle plantarflexors' hypertonia in people with multiple sclerosis. Mult Scler Relat Disord 2024; 91:105855. [PMID: 39236648 DOI: 10.1016/j.msard.2024.105855] [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: 05/19/2024] [Revised: 08/07/2024] [Accepted: 08/28/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND This study aimed at quantifying ankle plantarflexors' resistance to passive motion (RPM) by isokinetic dynamometry and muscle activity through surface electromyography (sEMG) in persons with multiple sclerosis (PwMS) with limb stiffness and spasticity. METHODS Slow and fast ankle dorsiflexions (from 5°/s to 210°/s) were imparted passively by an isokinetic dynamometer, and sEMG activity of plantarflexors was recorded at the same time as the square root of the moving average. Based on RPM evaluated at 5°/s, ankles were classified as more- and less-resistant as measured by average peak torque (APT). RESULTS Measurements were obtained bilaterally from 24 PwMS (median EDSS: 5.5) with median Modified Ashworth Scale (MAS) score of 1.75. Compared to the lowest velocity inducing EMG-evident responses (120°/s), RPM increased significantly at 180°/s (+137.8 %; p < 0.0005) and 210°/s (+85.3 %; p < 0.0005) in the less-resistant side, and only at 210°/s (+113.8 %; p < 0.0005) in the more-resistant side. sEMG activity increased significantly and similarly between limbs at increasing velocities. Significant velocity-dependent increases were detected in both limbs, with no difference by side, at 180°/s (+34.5 %; p = 0.005) and 210°/s (+48.4 %; p = 0.004). Regression analyses confirmed side (β=0.542; p < 0.0001) and speed (β=0.238; p < 0.0001) as significant predictors of APT change, but only speed for sEMG (speed: β=0.215; p = 0.019; side: β=0.012; p = 0.893). Bivariate correlations revealed that RPM was associated negatively with MAS and positively with sEMG. CONCLUSION Spasticity presented bilaterally in PwMS, with different mixed pictures of passive and reflex stiffness, both requiring attention. Combining isokinetics and sEMG allows detecting even subtle, subclinical alterations that can prompt and drive early tailored management.
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Affiliation(s)
- Anna Boi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Lucia Ventura
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Gianluca Martinez
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Marco Morrone
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Elena Aiello
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy; Unit of Endocrinology, Nutrition, and Metabolic Disorders, AOUSS, Sassari, Italy.
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Fernández Fernández Ó, Costa-Frossard L, Martínez Ginés ML, Montero Escribano P, Prieto González JM, Ramió-Torrentà L, Aladro Y, Alonso Torres A, Álvarez Rodríguez E, Labiano-Fontcuberta A, Landete Pascual L, Miralles Martínez A, Moral Torres E, Oliva-Nacarino P. Practical tool to identify Spasticity-Plus Syndrome amongst patients with multiple sclerosis. Algorithm development based on a conjoint analysis. Front Neurol 2024; 15:1371644. [PMID: 38708001 PMCID: PMC11066270 DOI: 10.3389/fneur.2024.1371644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/25/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction The Spasticity-Plus Syndrome (SPS) in multiple sclerosis (MS) refers to a combination of spasticity and other signs/symptoms such as spasms, cramps, bladder dysfunction, tremor, sleep disorder, pain, and fatigue. The main purpose is to develop a user-friendly tool that could help neurologists to detect SPS in MS patients as soon as possible. Methods A survey research based on a conjoint analysis approach was used. An orthogonal factorial design was employed to form 12 patient profiles combining, at random, the eight principal SPS signs/symptoms. Expert neurologists evaluated in a survey and a logistic regression model determined the weight of each SPS sign/symptom, classifying profiles as SPS or not. Results 72 neurologists participated in the survey answering the conjoint exercise. Logistic regression results of the survey showed the relative contribution of each sign/symptom to the classification as SPS. Spasticity was the most influential sign, followed by spasms, tremor, cramps, and bladder dysfunction. The goodness of fit of the model was appropriate (AUC = 0.816). Concordance between the experts' evaluation vs. model estimation showed strong Pearson's (r = 0.936) and Spearman's (r = 0.893) correlation coefficients. The application of the algorithm provides with a probability of showing SPS and the following ranges are proposed to interpret the results: high (> 60%), moderate (30-60%), or low (< 30%) probability of SPS. Discussion This study offers an algorithmic tool to help healthcare professionals to identify SPS in MS patients. The use of this tool could simplify the management of SPS, reducing side effects related with polypharmacotherapy.
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Affiliation(s)
- Óscar Fernández Fernández
- Department of Pharmacology, Faculty of Medicine, Institute of Biomedical Research of Malaga (IBIMA), University of Malaga, Málaga, Spain
| | - Lucienne Costa-Frossard
- Department of Neurology, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | | | - Paloma Montero Escribano
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, San Carlos Clinical University Hospital, Madrid, Spain
| | - José María Prieto González
- Department of Neurology, Clinical University Hospital of Santiago, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Lluís Ramió-Torrentà
- Girona Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona-Salt, Spain
- Neurodegeneration and Neuroinflammation Research Group, IDIBGI, Girona-Salt, Spain
- Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
| | - Yolanda Aladro
- University Hospital of Getafe, European University of Madrid, University Hospital La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - Ana Alonso Torres
- Department of Neurology, Regional University Hospital of Malaga, Málaga, Spain
| | | | | | | | | | - Ester Moral Torres
- Department of Neurology, Moises Broggi University Hospital, Barcelona, Spain
| | - Pedro Oliva-Nacarino
- Department of Neurology, Central University Hospital of Asturias (HUCA), Institute of Health Research of the Principality of Asturias (ISPA), Oviedo, Spain
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Goicochea Briceño H, Higueras Y, Ruiz Pérez I, García Domínguez JM, Cuello JP, Meldaña Rivera A, Martínez Ginés ML. Spasticity-Plus syndrome in multiple sclerosis patients in a tertiary hospital in Spain. Front Neurol 2024; 15:1360032. [PMID: 38469589 PMCID: PMC10926473 DOI: 10.3389/fneur.2024.1360032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction Spasticity is a common symptom in multiple sclerosis (MS) and it is often associated with other symptoms such as spasms/cramps and pain. The concept of Spasticity-Plus syndrome takes into account that spasticity is accompanied by one or more symptoms (spasms/cramps, pain, bladder dysfunction, sleep disorders, fatigue and/or tremor). As these symptoms share a common cannabinoid control, therapy acting on cannabinoid receptors may be useful. The main study objectives were to determine the number of MS patients who met Spasticity-Plus syndrome criteria and to identify the most common symptoms. Methods Clinical records of MS patients treated with nabiximols in a tertiary hospital from 2002 to 2022 were reviewed retrospectively. Results Of the 73 patients included in the study, 53.4% were women, and most had secondary progressive MS (64.4%). All patients met the criteria for Spasticity-Plus syndrome: 100% had spasticity and at least another symptom. Pain was the second most common symptom (91.8%), followed by spasms/cramps (79.4%), and fatigue (76.7%). Sleep disturbances (p < 0.0001) and tremor (p < 0.027) were more frequent in patients with relapsing-remitting MS than in patients with progressive MS. No statistically significant differences were found for spasticity, pain, spasms/cramps, and fatigue between MS phenotypes. Regarding symptoms clusters, 94.4% of the patients had three or more symptoms. Spasticity was more frequently associated with pain (91.8%) and spasms/cramps (79.4%). Conclusion Spasticity-Plus syndrome was present in all the study population of patients with different MS phenotypes, and treated with nabiximols.
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Affiliation(s)
| | - Yolanda Higueras
- Facultad de Psicología, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Irene Ruiz Pérez
- Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Juan Pablo Cuello
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ariana Meldaña Rivera
- Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
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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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Novarella F, Carotenuto A, Cipullo P, Iodice R, Cassano E, Spiezia AL, Capasso N, Petracca M, Falco F, Iacovazzo C, Servillo G, Lanzillo R, Brescia Morra V, Moccia M. Persistence with Botulinum Toxin Treatment for Spasticity Symptoms in Multiple Sclerosis. Toxins (Basel) 2022; 14:toxins14110774. [PMID: 36356024 PMCID: PMC9693315 DOI: 10.3390/toxins14110774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/05/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
Botulinum toxin (BT) is an effective treatment for spasticity symptoms in multiple sclerosis (MS). Despite its wide use in clinical practices, only few studies have explored long-term persistence. We aim to evaluate the rate of discontinuation of BT treatment and the correlation with MS, spasticity, and injection variables. This retrospective study on 3-year prospectively collected data included 122 MS patients receiving BT injections for spasticity. We collected MS clinical variables (disease durations, Expanded Disability Status Scales [EDSSs], disease-modifying treatments [DMT], and Symbol Digit Modalities Tests [SDMTs]), modified Ashworth scales [MASs], concomitant treatments, and injection variables (formulation, dose, number of injections, and intervals between injections). A total of 14 out of the 122 patients discontinued BT after a mean time of 3.0 ± 1.5 years. In the Cox regression model including the MS clinical variables, the probability of BT discontinuations increased in patients with DMT changes during follow-ups (HR = 6.34; 95%Cl = 2.47, 18.08; p < 0.01) and with impaired SDMTs (HR = 1.20; 95%Cl = 1.04, 1.96; p < 0.01). In the model including the spasticity variables, there were no associations between BT discontinuation and MAS or other spasticity treatments. In the model including the injection variables, the probability of discontinuation decreased by 80% for each cumulative injection (HR = 0.16; 95%Cl = 0.05, 0.45; p < 0.01), but increased by 1% for each additional day over the 3-month interval between injections (HR = 1.27; 95%Cl = 1.07, 1.83; p < 0.01). BT discontinuation was associated with concomitant MS-related issues (e.g., treatment failure and DMT change) and the presence of cognitive impairment, which should be accounted for when planning injections. The interval between injections should be kept as short as possible from regulatory and clinical perspectives to maximize the response across all of the spasticity symptoms and to reduce discontinuation in the long term.
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Affiliation(s)
- Federica Novarella
- Multiple Sclerosis Clinical Care Unit, Federico II University Hospital, 80131 Naples, Italy
- Department of Neurosciences, Federico II University of Naples, 80131 Naples, Italy
| | - Antonio Carotenuto
- Multiple Sclerosis Clinical Care Unit, Federico II University Hospital, 80131 Naples, Italy
- Department of Neurosciences, Federico II University of Naples, 80131 Naples, Italy
| | - Paolo Cipullo
- Department of Neurosciences, Federico II University of Naples, 80131 Naples, Italy
| | - Rosa Iodice
- Multiple Sclerosis Clinical Care Unit, Federico II University Hospital, 80131 Naples, Italy
- Department of Neurosciences, Federico II University of Naples, 80131 Naples, Italy
| | - Emanuele Cassano
- Multiple Sclerosis Clinical Care Unit, Federico II University Hospital, 80131 Naples, Italy
- Department of Neurosciences, Federico II University of Naples, 80131 Naples, Italy
| | - Antonio Luca Spiezia
- Multiple Sclerosis Clinical Care Unit, Federico II University Hospital, 80131 Naples, Italy
- Department of Neurosciences, Federico II University of Naples, 80131 Naples, Italy
| | - Nicola Capasso
- Multiple Sclerosis Clinical Care Unit, Federico II University Hospital, 80131 Naples, Italy
- Department of Neurosciences, Federico II University of Naples, 80131 Naples, Italy
| | - Maria Petracca
- Multiple Sclerosis Clinical Care Unit, Federico II University Hospital, 80131 Naples, Italy
- Department of Neurosciences, Federico II University of Naples, 80131 Naples, Italy
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Fabrizia Falco
- Department of Neurosciences, Federico II University of Naples, 80131 Naples, Italy
| | - Carmine Iacovazzo
- Department of Neurosciences, Federico II University of Naples, 80131 Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Federico II University of Naples, 80131 Naples, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care Unit, Federico II University Hospital, 80131 Naples, Italy
- Department of Neurosciences, Federico II University of Naples, 80131 Naples, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care Unit, Federico II University Hospital, 80131 Naples, Italy
- Department of Neurosciences, Federico II University of Naples, 80131 Naples, Italy
| | - Marcello Moccia
- Multiple Sclerosis Clinical Care Unit, Federico II University Hospital, 80131 Naples, Italy
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, 80131 Naples, Italy
- Correspondence:
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Alami Marrouni K, Duquette P. Clinical insights on the spasticity-plus syndrome in multiple sclerosis. Front Neurol 2022; 13:958665. [PMID: 35989901 PMCID: PMC9390998 DOI: 10.3389/fneur.2022.958665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kanza Alami Marrouni
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Pierre Duquette
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Neurology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- *Correspondence: Pierre Duquette
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