Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
Neurol Sci. 2021 Dec;42(12):5037-5043. doi: 10.1007/s10072-021-05182-6. Epub 2021 Mar 19.
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.
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.
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.
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.
痉挛是多发性硬化症患者（PwMS）常见且致残的症状：正如许多流行病学研究强调的那样，痉挛通常是严重的且治疗效果不佳。尽管有基于证据的痉挛管理指南，但在日常治疗方法上仍存在很大差异，尤其是对于最复杂的病例。
在我们的单中心研究中，我们回顾性评估了 2015 年 7 月至 2019 年 4 月期间接受纳比昔单抗和肉毒毒素注射（BTI）治疗的 PwMS。收集了临床和人口统计学数据。在基线和治疗 1 个月后，使用改良 Ashworth 量表（mAS）和宾夕法尼亚痉挛频率量表（PSFS）记录痉挛和痉挛的严重程度。
我们评估了 64 例与 MS 相关的痉挛治疗：28 例患者接受 BTI 治疗，36 例患者接受纳比昔单抗治疗。我们发现 BTI 和纳比昔单抗均能有效降低 mAS（纳比昔单抗，BTI：p<0.001）、PSFS 频率（纳比昔单抗：p=0.001，BTI：p=0.008）和强度（纳比昔单抗：p=0.001，BTI p=0.016）。直接比较两种治疗方法的疗效时，没有发现差异，但在痉挛强度方面，BTI 有统计学趋势（p=0.091）。11 例患者同时接受 BTI 和纳比昔单抗治疗，仅 4 例患者继续两种治疗。所有脱落患者均因至少一种治疗无效。
我们的单中心经验表明，BTI 和纳比昔单抗均能有效治疗多发性硬化症相关痉挛；然而，BTI 治疗可能对痉挛强度更有效。纳比昔单抗和 BTI 联合治疗可能是严重痉挛的一种治疗选择。
