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Acta Neurol Scand. 2017 Apr;135(4):442-448. doi: 10.1111/ane.12660. Epub 2016 Aug 8.

Upper motor neuron evaluation in multiple sclerosis patients treated with Sativex®.

Author information

1
Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy.
2
Department of Neurology, Radiology, Neuroscience, Icahn School of Medicine, Mount Sinai, NY, USA.
3
Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
4
Department of Neurology, Icahn School of Medicine, Mount Sinai, NY, USA.

Abstract

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. We selected 20 MS patients without spasticity as control group at baseline.

RESULTS:

At baseline, cases showed a lower CST FA (0.492±0.045 vs 0.543±0.047; P=.01) and a higher CMCT (P=.001) compared to the control group. No correlations were found between clinical, electrophysiological, and MRI features. After 12 months, cases showed a decrease in non-prevalent degree of impairment (PDI) side FA (0.502±0.023 vs 0.516±0.033; P=.01) without differences for electrophysiological features compared to baseline. Treatment with Sativex® resulted in a reduction of NRS for spasticity (P=.01).

CONCLUSIONS:

We confirm the presence of CST impairment in MS patients with spasticity. We did not identify structural/electrophysiological correlates that could explain Sativex® clinical effect.

KEYWORDS:

Sativex; corticospinal tract; electrophysiological assessment; multiple sclerosis; spasticity

PMID:
27500463
DOI:
10.1111/ane.12660
[Indexed for MEDLINE]

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