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Nabiximols and botulinum toxin injections for patients with multiple sclerosis: efficacy on spasticity and spasms in a single-centre experience

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Abstract

Background

Spasticity is a common and disabling symptom in patients with multiple sclerosis (PwMS): as highlighted by many epidemiological studies, it is often a severe and not well treated. Despite the availability of evidence-based spasticity management guidelines, there is still great variability in everyday therapeutic approach, especially for the most complex cases.

Methods

In our single-centre study, we retrospectively evaluated PwMS-treated nabiximols and botulinum toxin injections (BTI) from July 2015 to April 2019. Clinical and demographic data were collected. The severity of spasticity and spasms was recorded by modified Ashworth Scale (mAS) and Penn Spasm Frequency Scale (PSFS) at baseline and after 1 month of treatment.

Results

We evaluated 64 treatments for MS-related spasticity: 28 patients were treated with BTI and 36 patients with nabiximols. We found that both BTI and nabiximols are effective in reducing mAS (nabiximols, BTI: p < 0.001), PSFS frequency (nabiximols: p = 0.001, BTI: p = 0.008) and intensity (nabiximols: p = 0.001, BTI p = 0.016). No differences were found when directly comparing the efficacy of the two treatments, except for a statistical trend favouring BTI on spasms intensity (p = 0.091). Eleven patients were treated with both BTI and nabiximols, and only four patients continued both treatments. All dropouts were due to inefficacy of at least one of the two therapies.

Conclusions

Our single-centre experience highlights that both BTI and nabiximols are effective in treating multiple sclerosis-related spasticity; however, BTI treatment may be more effective on spasms intensity. Combined nabiximols and BTI treatment could represent a therapeutic option for severe spasticity.

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Authors and Affiliations

  1. Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy

    Arianna Sartori, Alessandro Dinoto, Lara Stragapede, Giulia Mazzon, Maria Elisa Morelli, Fulvio Pasquin, Alessio Bratina, Antonio Bosco & Paolo Manganotti

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  1. Arianna Sartori
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  2. Alessandro Dinoto
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  3. Lara Stragapede
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  4. Giulia Mazzon
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Correspondence to Arianna Sartori.

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Conflict of interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Ethical approval

The protocol and procedures employed in this study were approved by the Local Ethical Committee. An informed consent was signed by all participants prior to assessment, according to the Declaration of Helsinski (October 2013 version).

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Highlights

• BTI and nabiximols are both effective in treating MS spasticity.

• BTI may be more effective in reducing spasms intensity.

• Nabiximols and BTI may be safely combined in patients with severe spasticity.

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Sartori, A., Dinoto, A., Stragapede, L. et al. Nabiximols and botulinum toxin injections for patients with multiple sclerosis: efficacy on spasticity and spasms in a single-centre experience. Neurol Sci 42, 5037–5043 (2021). https://doi.org/10.1007/s10072-021-05182-6

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