Upper motor neuron evaluation in multiple sclerosis patients treated with Sativex®
Upper motor neuron evaluation in multiple sclerosis patients treated with Sativex®
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DOI：
10.1111/ane.12660
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发表时间：
2017-04-01
影响因子：
3.5
通讯作者：
Orefice, G.
中科院分区：
文献类型：
--
作者：
Carotenuto, A.;Iodice, R.;Orefice, G.
背景：多发性硬化症（MS）的痉挛是由下行通路到脊髓运动回路的输入不平衡以及皮质脊髓束（CST）的损伤引起的。目的：评估伴有和不伴有痉挛的MS患者的CST损伤，并评估其在Sativex（(R)）治疗下的演变。方法：10例多发性硬化症痉挛患者（“病例”）在基线和12个月后接受临床（EDSS， 9孔Peg， Ashworth量表，定时25英尺步行，痉挛NRS）， MRI （CST分数各向异性[FA]）和电生理（中枢运动传导时间[CMCT]和H/M比）评估。我们选择20例无痉挛的MS患者作为基线对照组。结果：在基线时，与对照组相比，病例显示较低的CST FA （0.492 +/- 0.045 vs 0.543 +/- 0.047； P= 0.01）和较高的CMCT （P= 0.001）。临床、电生理和MRI特征之间没有相关性。12个月后，病例显示非流行损伤程度（PDI）侧FA下降（0.502 +/- 0.023 vs 0.516 +/- 0.033； P= 0.01），电生理特征与基线相比无差异。Sativex（(R)）治疗导致痉挛的NRS降低（P= 0.01）。结论：我们证实多发性硬化症痉挛患者存在CST损伤。我们没有发现结构/电生理相关因素可以解释Sativex(R)的临床效果。
Background: Spasticity in multiple sclerosis (MS) results from an imbalance of inputs from descending pathways to the spinal motor circuits, as well as from a damage of the corticospinal tract (CST).Objectives: To assess CST impairment in MS patients with and without spasticity and to evaluate its evolution under Sativex((R)) treatment.Methods: Ten MS patients with spasticity ("cases") underwent clinical (EDSS, 9-hole Peg, Ashworth scale, Timed 25-Foot Walk, and NRS for spasticity), MRI (CST fractional anisotropy [FA]), and electrophysiological (central motor conduction time [CMCT] and H/M ratio) evaluations at baseline and after 12 months. We selected 20 MS patients without spasticity as control group at baseline.Results: At baseline, cases showed a lower CST FA (0.492 +/- 0.045 vs 0.543 +/- 0.047; P=.01) and a higher CMCT (P=.001) compared to the control group. No correlations were found between clinical, electrophysiological, and MRI features. After 12 months, cases showed a decrease in non-prevalent degree of impairment (PDI) side FA (0.502 +/- 0.023 vs 0.516 +/- 0.033; P=.01) without differences for electrophysiological features compared to baseline. Treatment with Sativex((R)) resulted in a reduction of NRS for spasticity (P=.01).Conclusions: We confirm the presence of CST impairment in MS patients with spasticity. We did not identify structural/electrophysiological correlates that could explain Sativex((R)) clinical effect.