Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy.
Unit of Neurology, Regional Multiple Sclerosis Center, Borgo Roma Hospital, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
BMC Neurol. 2023 Mar 29;23(1):128. doi: 10.1186/s12883-023-03171-0.
Nabiximols (Sativex®) is a cannabinoid approved for multiple sclerosis (MS)-related spasticity. Its mechanism of action is partially understood, and efficacy is variable.
To conduct an exploratory analysis of brain networks connectivity changes on resting state (RS) functional MRI (fMRI) of MS patients treated with nabiximols.
We identified a group of MS patients treated with Sativex® at Verona University Hospital, who underwent RS brain fMRI in the 4 weeks before (T0) and 4-8 weeks after (T1) treatment start. Sativex® response was defined as ≥ 20% spasticity Numerical Rating Scale score reduction at T1 vs. T0. Connectivity changes on fMRI were compared between T0 and T1 in the whole group and according to response status. ROI-to-ROI and seed-to-voxel connectivity were evaluated.
Twelve MS patients (7 males) were eligible for the study. Seven patients (58.3%) resulted Sativex® responders at T1. On fMRI analysis, Sativex® exposure was associated with global brain connectivity increase (particularly in responders), decreased connectivity of motor areas, and bidirectional connectivity changes of the left cerebellum with a number of cortical areas.
Nabiximols administration is associated with brain connectivity increase of MS patients with spasticity. Modulation of sensorimotor cortical areas and cerebellum connectivity could play a role in nabiximols effect.
Nabiximols（Sativex®）是一种已被批准用于多发性硬化症（MS）相关痉挛的大麻素。其作用机制部分被理解，疗效是可变的。
对接受 Nabiximols 治疗的 MS 患者的静息状态（RS）功能磁共振成像（fMRI）脑网络连接变化进行探索性分析。
我们在维罗纳大学医院确定了一组接受 Sativex®治疗的 MS 患者，他们在治疗开始前的 4 周（T0）和 4-8 周（T1）接受了 RS 脑 fMRI。Sativex®反应定义为 T1 与 T0 相比，痉挛数字评定量表评分降低≥20%。在全组和根据反应状态比较 T0 和 T1 时的 fMRI 上的连接变化。评估 ROI-to-ROI 和种子到体素的连接。
12 名 MS 患者（7 名男性）符合研究条件。7 名患者（58.3%）在 T1 时为 Sativex®反应者。在 fMRI 分析中，Sativex®暴露与大脑整体连接增加相关（特别是在反应者中），运动区连接减少，左小脑与多个皮质区的双向连接变化。
Nabiximols 给药与痉挛性 MS 患者的脑连接增加有关。感觉运动皮质区和小脑连接的调制可能在 Nabiximols 的作用中发挥作用。
