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Multiple sclerosis spasticity

Giovanna Squintani, Francesco Donato, Mara Turri, Luciano Deotto, Francesco Teatini, Giuseppe Moretto, Roberto Erro
BACKGROUND: Delta-9-tetrahydrocannabinol and cannabidiol (THC:CBD) oromucosal spray (Sativex®) has been recently approved for the management of treatment-resistant multiple sclerosis (MS) spasticity. Although the symptomatic relief of Sativex® on MS-spasticity has been consistently demonstrated, the pathogenetic implications remain unclear and the few electrophysiological studies performed to address this topic yielded controversial results. We therefore aimed to investigate the mechanisms underpinning the modulation of spastic hypertonia by Sativex®, at both central and spinal levels, through an extensive neurophysiological battery in patients with MS...
November 15, 2016: Journal of the Neurological Sciences
Patrick Vermersch, Maria Trojano
BACKGROUND: Tetrahydrocannabinol:cannabidiol (THC:CBD) oromucosal spray (Sativex®) is an add-on therapy for moderate-to-severe multiple sclerosis (MS)-related drug-resistant spasticity (MSS). AIM: The MOVE-2 EU study collected data from everyday clinical practice concerning the effectiveness and tolerability of THC:CBD. METHODS: This was an observational, prospective, multicentre, non-interventional study. Patients with resistant MSS prescribed add-on THC:CBD oromucosal spray according to approved labelling, were followed for 3 months...
October 13, 2016: European Neurology
François Kopciuch
OBJECTIVE: Walking disorders are common in patients with multiple sclerosis (MS). Among these, walking fatigability is a common complaint of patients, but it needs to be better characterized. This work aims to compare the fatigability induced by a 2, and a 6- minute walk test (2MWT; 6MWT) and to investigate the factors associated with it. MATERIALS/PATIENTS AND METHODS: Twenty-seven MS patients (divided into subgroups according to disease severity [EDSS 3-4 and 4...
September 2016: Annals of Physical and Rehabilitation Medicine
Philippe Gallien, Benoit Nicolas, Leblong Emilie, Sabine Petrilli, Sandrine Robineau, Aurelie Durufle, Katell Autret, Tiphaine Berthier, Lucie Chochina, Bastien Fraudet, Corinne Pfeiffer
INTRODUCTION: Few data are available on the use of botulinum toxin for spasticity treatment in multiple sclerosis. In a previous study, we found that one of the main therapeutic goals was the improvement ok walking, in patients suffering from spasticity of the triceps surae. OBJECTIVE: This is a pilot observational study, with the aim to assess the benefit of an injection of 200 UI of incobotulinumtoxin A in multiple sclerosis patients suffering from spasticity du triceps surae...
September 2016: Annals of Physical and Rehabilitation Medicine
M A Akulov, S E Khat'kova, O A Mokienko, O R Orlova, D Yu Usachev, V O Zakharov, A S Orlova, A A Tomsky
Spasticity is a type of muscle hyperactivity that occurs in patients after focal lesions of the Central nervous system due to various diseases: stroke, traumatic brain injury or spinal cord injury, neurosurgical intervention, as well as multiple sclerosis and other diseases of the Central nervous system and is the most disability manifestation of the syndrome of upper motor neuron (UMNS). Focal spasticity of the upper limb requires a complex treatment. Botulinum toxin therapy is an effective treatment for focal/multifocal spasticity in reducing muscle tone and improving function with the highest level of evidence according to the latest American and European guidelines for treatment of spasticity...
2016: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
Soofia Naghdi, Noureddin Nakhostin Ansari, Sedighe Ghorbani-Rad, Maryam Senobari, Mohammad Ali Sahraian
The reliability of the Modified Tardieu Scale (MTS) has not been examined in patients with multiple sclerosis (MS). This study aimed to assess intra-rater reliability of the MTS in the assessment of lower limb spasticity in patients with MS. Data from 30 patients with MS (18 women, mean age = 41.5) were used to assess intra-rater reliability. An inexperienced physiotherapist in the scale randomly examined the hip adductors, knee extensors, and ankle plantar flexors on each subject twice with at least a 7-day interval...
September 12, 2016: Neurological Sciences
Stefano Paolucci, Andrea Martinuzzi, Giorgio Scivoletto, Nicola Smania, Claudio Solaro, Irene Aprile, Michela Armando, Roberto Bergamaschi, Eliana Berra, Giulia Berto, Elena Carraro, Monica Cella, Marialuisa Gandolfi, Marcella Masciullo, Marco Molinari, Emanuela Pagliano, Cristiano Pecchioli, Laura Roncari, Monica Torre, Erika Trabucco, Gabriella Vallies, Paolo Zerbinati, Stefano Tamburin
Pain is a common and disabling symptom in patients with stroke, multiple sclerosis (MS), cerebral palsy (CP), spinal cord injury (SCI) and other conditions associated with spasticity, but data on its prevalence, and natural history, as well as guidelines on its assessment and treatment in the field of neurorehabilitation, are largely lacking. The Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) searched and evaluated current evidence on the frequency, evolution, predictors, assessment, and pharmacological and non-pharmacological treatment of pain in patients with stroke, MS, CP, SCI and other conditions associated with spasticity...
August 31, 2016: European Journal of Physical and Rehabilitation Medicine
Emanuele Spina, Antonio Carotenuto, Maria Gabriella Aceto, Ilaria Cerillo, Francesco Silvestre, Francesco Arace, Paolo Paone, Giuseppe Orefice, Rosa Iodice
BACKGROUND: Multiple Sclerosis is a heterogeneous disorders involving in early stage gait and balance. Together with immunomodulating therapies, rehabilitation had a crucial role in improving motor tasks and quality of life. Between the emerging techniques, Focal Vibrations (FV) could play a role, but they have been used in MS only to reduce muscle tone and fatigue alone or together with botulinum toxin. OBJECTIVE: To assess whether FV is effective on walking impairment in a cohort of MS patients...
September 21, 2016: Restorative Neurology and Neuroscience
Sarah J Shoemaker, Alyssa Pozniak, Louise Hadden
BACKGROUND: Although hundreds of quality indicators (QIs) have been developed for various chronic conditions, QIs specific to multiple sclerosis (MS) care have only recently been developed. We sought to examine the extent to which the self-reported care of individuals with MS meets four recently developed MS QIs related to treatment of depression, spasticity, and fatigue and timely initiation of disease-modifying agents (DMAs) for relapsing MS. METHODS: Using the Sonya Slifka Study data, we examined the proportion of the MS population meeting four QIs (based on patient-reported data) in a sample of individuals with MS in 2007-2009...
July 2016: International Journal of MS Care
A Carotenuto, R Iodice, M Petracca, M Inglese, I Cerillo, S Cocozza, C Saiote, A Brunetti, E Tedeschi, F Manganelli, G Orefice
BACKGROUND: Spasticity in multiple sclerosis (MS) results from an imbalance of inputs from descending pathways to the spinal motor circuits, as well as from a damage of the corticospinal tract (CST). OBJECTIVES: To assess CST impairment in MS patients with and without spasticity and to evaluate its evolution under Sativex(®) treatment. METHODS: Ten MS patients with spasticity ("cases") underwent clinical (EDSS, 9-hole Peg, Ashworth scale, Timed 25-Foot Walk, and NRS for spasticity), MRI (CST fractional anisotropy [FA]), and electrophysiological (central motor conduction time [CMCT] and H/M ratio) evaluations at baseline and after 12 months...
August 8, 2016: Acta Neurologica Scandinavica
María Asunción Fernández-Pablos, Lucienne Costa-Frossard, Carlos García-Hernández, Inmaculada García-Montes, Matilde Escutia-Roig
OBJECTIVE: To describe the role of nurses in the management of symptoms related to spasticity in patients with multiple sclerosis (MS). METHOD: A descriptive study was developed based on a questionnaire on spasticity in MS patients. The questionnarie was completed through an anonymous tele-voting system at a national meeting with nurses involved in the management of these patients. RESULTS: Apart from fatigue, according to the opinion of the participants, the spasticity symptom associated with MS most notified by patients was difficulty in walking, followed by spasms and pain...
August 1, 2016: Enfermería Clínica
Alessandra Pompa, Giovanni Morone, Marco Iosa, Luca Pace, Sheila Catani, Paolo Casillo, Alessandro Clemenzi, Elio Troisi, Angelo Tonini, Stefano Paolucci, Maria Grazia Grasso
BACKGROUND: Robotic training is commonly used to assist walking training in patients affected by multiple sclerosis (MS) with non-conclusive results. OBJECTIVE: To compare the effect of robot-assisted gait training (RAGT) with that of conventional walking training (CWT) on gait competencies, global ability, fatigue and spasticity in a group of severely affected patients with MS. METHODS: A pilot, single-blind randomized controlled trial was conducted in 43 severe (Expanded Disability Status Scale (EDSS) score of 6-7...
August 2, 2016: Multiple Sclerosis: Clinical and Laboratory Research
E Fernández-Tenorio, D Serrano-Muñoz, J Avendaño-Coy, J Gómez-Soriano
INTRODUCTION: Although transcutaneous electrical nerve stimulation (TENS) has traditionally been used to treat pain, some studies have observed decreased spasticity after use of this technique. However, its use in clinical practice is still limited. Our purpose was twofold: to determine whether TENS is effective for treating spasticity or associated symptoms in patients with neurological involvement, and to determine which stimulation parameters exert the greatest effect on variables associated with spasticity...
July 26, 2016: Neurología: Publicación Oficial de la Sociedad Española de Neurología
M Russo, R De Luca, M Torrisi, C Rifici, E Sessa, P Bramanti, A Naro, R S Calabrò
OBJECTIVE: Sativex® is an exclusive cannabinoid-based drug approved for the treatment of spasticity due to Multiple Sclerosis (MS). The most common side effects include dizziness, nausea, and somnolence. However, it is still under debate whether the drug could cause negative cognitive effects. The aim of our study was to investigate the effect of Sativex® on functional and psychological status in cannabis-naïve MS patients. PATIENTS AND METHODS: All the study participants (i...
July 2016: European Review for Medical and Pharmacological Sciences
Alberto Gajofatto
INTRODUCTION: Nabiximols is a cannabinoid compound approved for the treatment of multiple sclerosis (MS)-related spasticity. However, additional symptoms, such as pain, urinary urgency and sleep disturbance, may benefit from treatment. CASE REPORT: The present report describes a patient with secondary progressive MS and severe lower limbs spasticity who was started on treatment with nabiximols. The patient also suffered from trigeminal neuralgia, which he was not treating due to inefficacy or side effects of all previously tried medications...
July 2016: Multiple Sclerosis and related Disorders
Michael C Levin, Sangmin Lee, Lidia A Gardner, Yoojin Shin, Joshua N Douglas, Hannah Salapa
Several years following its discovery in 1980, infection with human T-lymphotropic virus type 1 (HTLV-1) was shown to cause HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP), a disease biologically similar to progressive forms of multiple sclerosis (MS). In this manuscript, we review some of the clinical, pathological, and immunological similarities between HAM/TSP and MS with an emphasis on how autoantibodies to an RNA binding protein, heterogeneous nuclear ribonuclear protein A1 (hnRNP A1), might contribute to neurodegeneration in immune mediated diseases of the central nervous system...
July 17, 2016: Journal of Neuroimmunology
Víctor Manuel Rivera-Olmos, Marisela C Parra-Bernal
The consumption of marijuana extracted from Cannabis sativa and indica plants involves an important cultural impact in Mexico. Their psychological stimulatory effect is widely recognized; their biochemical and molecular components interact with CB1 and CB2 (endocannabinoid system) receptors in various central nervous system structures (CNS) and immune cells. The psychoactive element Δ-9-tetrahydrocannabinol (THC) can be reproduced synthetically. Systematic reviews show evidence of therapeutic effectiveness of therapeutic marijuana only for certain symptoms of multiple sclerosis (spasticity, spasms and pain), despite attempts for its widespread use, including refractory childhood epilepsy...
September 2016: Revista Médica del Instituto Mexicano del Seguro Social
O M Rønning, K D Tornes
OBJECTIVE: A majority of patients with advanced multiple sclerosis (MS) need symptomatic treatment. Many MS-related symptoms may not be recognized and thus are not treated. We conducted a study to estimate the prevalence of inadequate symptomatic treatment of patients with advanced MS. METHODS: Patients with advanced MS admitted to a specialist MS rehabilitation clinic were included in this study. Severity was assessed using the Expanded Disability Status Scale (EDSS)...
June 29, 2016: Acta Neurologica Scandinavica
Marta Simone, Tanuja Chitnis
Pediatric multiple sclerosis (PedMS) is a rare disease with a more severe prognosis compared to adult-onset MS. It remains a challenging condition to treat because of the highly inflammatory nature of the disease, the prominent cognitive issues, and the limited knowledge about the efficacy and safety of current available disease-modifying therapies. Over the past decade, there has been a dramatic increase in the number of drugs licensed for adult-onset MS and several of them, although not tested in PedMS, are currently being used off-label in this population...
August 2016: Current Treatment Options in Neurology
S Skierlo, P S Rommer, U K Zettl
OBJECTIVE: To analyze symptomatic treatment in patients with multiple sclerosis (MS). BACKGROUND: Multiple sclerosis is a chronic inflammatory disease of the central nervous system, with accumulating disability symptoms like spasticity, voiding disorders, depression, and pain might occur. MATERIAL AND METHODS: The nationwide German MS registry was initiated 2001 under guidance of the German MS society (Deutsche MS Gesellschaft). This study was performed as an interim analysis to lay foundation for future work on this topic...
June 9, 2016: Acta Neurologica Scandinavica
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