Russo Margherita, Calabrò Rocco Salvatore, Naro Antonino, Sessa Edoardo, Rifici Carmela, D'Aleo Giangaetano, Leo Antonino, De Luca Rosaria, Quartarone Angelo, Bramanti Placido
IRCCS Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS 113, 98124 Messina, Italy.
Department of Neurosciences, University of Messina, Messina, Italy.
Neural Plast. 2015;2015:656582. doi: 10.1155/2015/656582. Epub 2015 Jan 29.
Sativex is an emergent treatment option for spasticity in patients affected by multiple sclerosis (MS). This oromucosal spray, acting as a partial agonist at cannabinoid receptors, may modulate the balance between excitatory and inhibitory neurotransmitters, leading to muscle relaxation that is in turn responsible for spasticity improvement. Nevertheless, since the clinical assessment may not be sensitive enough to detect spasticity changes, other more objective tools should be tested to better define the real drug effect. The aim of our study was to investigate the role of Sativex in improving spasticity and related symptomatology in MS patients by means of an extensive neurophysiological assessment of sensory-motor circuits. To this end, 30 MS patients underwent a complete clinical and neurophysiological examination, including the following electrophysiological parameters: motor threshold, motor evoked potentials amplitude, intracortical excitability, sensory-motor integration, and Hmax/Mmax ratio. The same assessment was applied before and after one month of continuous treatment. Our data showed an increase of intracortical inhibition, a significant reduction of spinal excitability, and an improvement in spasticity and associated symptoms. Thus, we can speculate that Sativex could be effective in reducing spasticity by means of a double effect on intracortical and spinal excitability.
替扎尼定是治疗多发性硬化症（MS）患者痉挛的一种新兴治疗选择。这种口腔黏膜喷雾剂作为大麻素受体的部分激动剂，可能调节兴奋性和抑制性神经递质之间的平衡，从而导致肌肉松弛，进而改善痉挛。然而，由于临床评估可能不够敏感，无法检测到痉挛的变化，因此应测试其他更客观的工具，以更好地确定药物的实际效果。我们研究的目的是通过对感觉运动回路进行广泛的神经生理学评估，来研究替扎尼定在改善MS患者痉挛及相关症状方面的作用。为此，30例MS患者接受了全面的临床和神经生理学检查，包括以下电生理参数：运动阈值、运动诱发电位幅度、皮质内兴奋性、感觉运动整合以及Hmax/Mmax比值。在连续治疗一个月前后进行了相同的评估。我们的数据显示皮质内抑制增加、脊髓兴奋性显著降低，以及痉挛和相关症状得到改善。因此，我们可以推测替扎尼定可能通过对皮质内和脊髓兴奋性的双重作用有效减轻痉挛。
