![]() ![]() This article will assess the current fragmented approaches to pharmacological management of spasticity muscle tone increase-related symptoms and their shortcomings. Given that different agents are used for different symptoms and a patient may have several symptoms present at the same time, many MS patients are multi-medicated, particularly as most patients will also be receiving disease-modifying therapies. These symptoms can have a major impact on patient's quality of life ( 3) and their management is considered important, although traditionally, this area has received far less attention than disease-modifying therapies ( 4).Ī wide range of treatments are available to manage each of the MS symptoms ( 5– 7). Nevertheless, MS currently remains incurable and, in most patients, disability will eventually progress and they must live with the very many symptoms associated with the disease. In the last two decades, the availability of new disease-modifying therapies has radically changed the management of multiple sclerosis (MS) and relapsing–remitting MS in particular ( 1), resulting in a longer life expectancy for patients with the disease ( 2). This would result in an important advance in the symptomatic management of MS. If this holds true, there exists the possibility to treat several spasticity-related symptoms induced by MS pathology with a single therapy, which would permit to avoid the unnecessary adverse effects produced by polytherapy. ![]() We can conceptualize and, therefore, hypothesize, through this indirect information, that it could be considered the existence of a broad “Spasticity-Plus Syndrome” that involves, a cluster of symptoms apart from spasticity itself, the rest of the mentioned functions/symptoms, probably because they are interlinked after the increase of muscle tone and mediated, at least in part, in the same or close areas of the brainstem. In several clinical trials with Nabiximols for MS spasticity, the investigators report improvement not only in spasticity itself, but also in several functions/symptoms mentioned before (spasms, cramps, pain, gait, sleep, bladder function, fatigue, and possibly tremor). Nabiximols (a combination of THC and CBD oromucosal spray) interact with both CB 1 and CB 2 receptors. Cannabinoid receptors are distributed throughout the CNS irregularly: There is an accumulation of CB 1 and CB 2 receptors in the brainstem. Several important functions/symptoms (muscle tone, sleep, bladder, pain) are mediated, in great part, in the brainstem. Appropriate symptomatic therapy is an unmet need. Symptomatic therapy of one MS symptom can cause or worsen other unwanted symptoms (anticholinergics used for bladder dysfunction produce impairment of cognition, many MS drugs produce erectile dysfunction, etc.). Due to this fact, MS produces a wide array of symptoms. Multiple sclerosis (MS) pathology progressively affects multiple central nervous system (CNS) areas. 6Servicio de Neurologia, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain.5Servicio de Neurologia, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.4Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain.3Department of Neurology, Gregorio Marañón Hospital, Madrid, Spain.2Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain.1Biomedical Research Institute of Malaga, University of Málaga, Málaga, Spain.Óscar Fernández 1 *, Lucienne Costa-Frossard 2, Marisa Martínez-Ginés 3, Paloma Montero 4, José Maria Prieto 5 and Lluis Ramió 6 ![]()
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