Nabiximols and botulinum toxin injections for patients with multiple sclerosis: efficacy on spasticity and spasms in a single-centre experience.

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.

• Authors: Arianna Sartori, Alessandro Dinoto, Lara Stragapede, Giulia Mazzon, Maria Elisa Morelli, Fulvio Pasquin, Alessio Bratina, Antonio Bosco, Paolo Manganotti
• Journal: Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology (Neurol Sci) Vol. 42 Issue 12 Pg. 5037-5043 (Dec 2021) ISSN: 1590-3478 [Electronic] Italy
• PMID: 33742336 (Publication Type: Journal Article)
• Copyright: © 2021. Fondazione Società Italiana di Neurologia.

Chemical References

• Drug Combinations
• Cannabidiol
• Dronabinol
• Botulinum Toxins
• Botulinum Toxins, Type A
• nabiximols

Topics

• Botulinum Toxins
• Botulinum Toxins, Type A (therapeutic use)
• Cannabidiol
• Dronabinol
• Drug Combinations
• Humans
• Multiple Sclerosis (complications, drug therapy)
• Muscle Spasticity (drug therapy, etiology)
• Retrospective Studies
• Spasm (drug therapy)
• Treatment Outcome