Fernandez Oscar, Costa-Frossard Lucienne, Martínez-Ginés Maria Luisa, Montero Paloma, Prieto-González Jose María, Ramió-Torrentà Lluís
Department of Pharmacology, Biomedical Research Institute of Malaga, University of Málaga, Málaga, Spain.
Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Front Neurol. 2021 Sep 27;12:722801. doi: 10.3389/fneur.2021.722801. eCollection 2021.
Multiple sclerosis (MS) treatment has radically improved over the last years; however, MS symptom management is still challenging. The novel Spasticity-Plus syndrome was conceptualized to frame several spasticity-related symptoms that can be addressed together with broad-spectrum medication, such as certain cannabinoid-based drugs. The aim of this project was to gain insight into Spanish neurologists' clinical experience on MS spasticity and associated symptoms, and to assess the acknowledgment and applicability of the Spasticity-Plus syndrome concept in patients with MS. Ten online meetings were conducted using the Workmat methodology to allow structured discussions. Fifty-five Spanish neurologists, experts in MS management, completed and discussed a set of predefined exercises comprising MS symptom assessment and its management in clinical practice, MS symptoms clustering in clinical practice, and their perception of the Spasticity-Plus syndrome concept. This document presents the quantitative and qualitative results of these discussions. The specialists considered that polytherapy is a common concern in MS and that simplifying the management of MS spasticity and associated manifestations could be useful. They generally agreed that MS spasticity should be diagnosed before moderate or severe forms appear. According to the neurologists' clinical experience, symptoms commonly associated with MS spasticity included spasms/cramps (100% of the specialists), pain (85%), bladder dysfunction (62%), bowel dysfunction (42%), sleep disorders (42%), and sexual dysfunction (40%). The multiple correspondence analysis revealed two main symptom clusters: spasticity-spasms/cramps-pain, and ataxia-instability-vertigo. Twelve out of 16 symptoms (75%) were scored >7 in a 0-10 QoL impact scale by the specialists, representing a moderate-high impact. The MS specialists considered that pain, spasticity, spasms/cramps, bladder dysfunction, and depression should be a treatment priority given their frequency and chance of therapeutic success. The neurologists agreed on the usefulness of the new Spasticity-Plus syndrome concept to manage spasticity and associated symptoms together, and their experience with treatments targeting the cannabinoid system was satisfactory. The applicability of the new concept of Spasticity-Plus in MS clinical practice seems possible and may lead to an integrated management of several MS symptoms, thus reducing the treatment burden of disease symptoms.
在过去几年中，多发性硬化症（MS）的治疗有了根本性的改善；然而，MS症状的管理仍然具有挑战性。新的“痉挛附加综合征”被概念化，以涵盖几种与痉挛相关的症状，这些症状可以通过广谱药物（如某些基于大麻素的药物）一起治疗。本项目的目的是深入了解西班牙神经科医生在MS痉挛及相关症状方面的临床经验，并评估“痉挛附加综合征”概念在MS患者中的认可度和适用性。使用Workmat方法进行了十次在线会议，以进行结构化讨论。五十五位西班牙MS管理专家完成并讨论了一组预定义的练习，包括MS症状评估及其在临床实践中的管理、临床实践中MS症状的聚类以及他们对“痉挛附加综合征”概念的看法。本文展示了这些讨论的定量和定性结果。专家们认为，联合治疗是MS中一个常见的问题，简化MS痉挛及相关表现的管理可能会有所帮助。他们普遍同意，MS痉挛应在中度或重度形式出现之前进行诊断。根据神经科医生的临床经验，通常与MS痉挛相关的症状包括痉挛/抽筋（100%的专家提到）、疼痛（85%）、膀胱功能障碍（62%）、肠道功能障碍（42%）、睡眠障碍（42%）和性功能障碍（40%）。多重对应分析揭示了两个主要症状群：痉挛-痉挛/抽筋-疼痛，以及共济失调-不稳-眩晕。在0-10的生活质量影响量表中，16种症状中有12种（75%）被专家评为>7分，代表中度至高度影响。MS专家认为，鉴于疼痛、痉挛、痉挛/抽筋、膀胱功能障碍和抑郁的发生频率和治疗成功的可能性，应将其作为治疗重点。神经科医生一致认为，新的“痉挛附加综合征”概念对于一起管理痉挛及相关症状是有用的，并且他们对针对大麻素系统的治疗经验是令人满意的。“痉挛附加综合征”的新概念在MS临床实践中的适用性似乎是可行的，并且可能导致对几种MS症状的综合管理，从而减轻疾病症状的治疗负担。
