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THC/CBD oromucosal spray in patients with multiple sclerosis overactive bladder: a pilot prospective study


Lower urinary tract dysfunctions (LUTDs) are commonly reported in multiple sclerosis (MS) patients and are mainly related to neurogenic overactive bladder (OAB). The aim of this observational study was to assess the effect of a tetrahydrocannabinol-cannabidiol (THC/CBD) oromucosal spray on resistant OAB by means of clinical and instrumental tools. Twenty-one MS patients were screened, and 15 cases have been evaluated. They underwent a specific clinical assessment (overactive bladder symptom score, OABSS) and a urodynamic assessment evaluating the maximal cystometric capacity (CCmax), bladder compliance (Qmax), maximum detrusor pressure (Pdet max), detrusor pressure at the first desire (Pdet first), bladder volume at the first desire (BVFD), leakage volume (LV), and post-void residual volume (PVR), before and after 4 weeks of THC/CBD administration. A complete neurological evaluation, including the assessment of their spasticity using the Modified Ashworth Scale (MAS) and the spasticity 0–10 numerical rating scale (NRS), was performed at the same times. Mobility was evaluated through the 25-ft walking-time test (T25-WT). The THC/CBD treatment successfully reduced the OAB symptoms (p = 0.001). Regarding the urodynamic findings after the end of treatment, PVR was significantly reduced (p = 0.016). Regarding the urodynamic findings after the end of treatment, PVR was significantly reduced (p = 0.016), while BVFD and CCmax were increased although the difference was not statistically significant. THC/CBD oromucosal spray has shown to be effective in improving overactive bladder symptoms in MS patients demonstrating a favorable impact on detrusor overactivity.

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Correspondence to Giorgia Teresa Maniscalco.

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Conflicts of interest

Giorgia Teresa Maniscalco received personal compensation from Novartis, Genzyme, Biogen, Merck Serono, and TEVA for public speaking and advisory boards.

Roberto Aponte does not have disclosures.

Dario Bruzzese does not have disclosures.

Giovanni Guarcello does not have disclosures.

Massimo Napolitano does not have disclosures.

Valentino Manzo does not have disclosures.

Ornella Moreggia does not have disclosures.

Francesco Chiariello does not have disclosure.

Ciro Florio received personal compensation from Merk Serono, Biogen, and TEVA for public speaking and advisory boards.

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Maniscalco, G.T., Aponte, R., Bruzzese, D. et al. THC/CBD oromucosal spray in patients with multiple sclerosis overactive bladder: a pilot prospective study. Neurol Sci 39, 97–102 (2018).

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  • Multiple sclerosis
  • Spasticity
  • Cannabinoids
  • Nabiximols
  • Sativex
  • LUTDs