Bruno Antonio, Dolcetti Ettore, Centonze Diego
Synaptic Immunopathology Lab, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
Department of Neurorehabilitation, Unit of Neurology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy.
Front Neurol. 2022 Feb 7;12:802918. doi: 10.3389/fneur.2021.802918. eCollection 2021.
In patients with multiple sclerosis (MS), a typical pattern of muscle tone alteration, known as spasticity, is frequently observed in combination with other signs or symptoms such as spasms, cramps, pain, bladder dysfunction, sleep disturbances, fatigue, and tremor. Recently, the concept of spasticity-plus syndrome (SPS) has been proposed to take into account the frequent coexistence of all these complaints in patients with MS and a common pathophysiological basis for this putative new clinical entity has been proposed. Muscle tone, sleep, bladder function, and the pain pathway are controlled by cannabinoid CB1 (CB1R) and CB2 receptors (CB2R) that are particularly enriched in the brainstem. Axons with smaller diameters are particularly susceptible to conduction block and the irritative, ephaptic, consequences of demyelination and their involvement in the demyelination process caused by MS in the brainstem might underlie the various clinical manifestations of SPS. The adoption of SPS in clinical practice could be useful to improve symptomatic treatments in a significant proportion of patients with MS, possibly limiting the adverse events produced by polypharmacotherapy.
在多发性硬化症（MS）患者中，一种典型的肌张力改变模式，即痉挛，常与其他体征或症状同时出现，如痉挛、抽筋、疼痛、膀胱功能障碍、睡眠障碍、疲劳和震颤。最近，有人提出了痉挛加综合征（SPS）的概念，以考虑到MS患者中所有这些症状的频繁共存，并提出了这一假定新临床实体的共同病理生理基础。肌张力、睡眠、膀胱功能和疼痛通路受大麻素CB1（CB1R）和CB2受体（CB2R）控制，这些受体在脑干中特别丰富。直径较小的轴突特别容易受到传导阻滞以及脱髓鞘的刺激性、触突性后果的影响，它们参与MS在脑干中引起的脱髓鞘过程可能是SPS各种临床表现的基础。在临床实践中采用SPS可能有助于改善相当一部分MS患者的症状性治疗，可能会限制多药治疗产生的不良事件。
