title: Treatment failure of intrathecal baclofen and supra-additive effect of nabiximols in multiple sclerosis-related spasticity: a case report.
abstract: Multiple sclerosis (MS)-related spasticity is associated with disability and impairment in quality of life. We report on a patient with secondary progressive MS and spastic tetraparesis (Expanded Disability Status Scale score 8.5). The right arm exhibited flexor spasticity resulting in functional disability despite multimodal symptomatic treatment. Intrathecal baclofen led to side effects despite decreasing efficacy. Low-dose nabiximols improved spasticity and function with recovery of daily-life activities and spasticity-related symptoms. Reduction of intrathecal baclofen ameliorated adverse drug reactions. Add-on cannabinoid therapy was effective in therapy-refractory spasticity with supra-additive effect in combining intrathecal baclofen and nabiximols, hypothetically explained by mutually complementing mechanisms of action.
authors: Department of Neurology, St Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, D-44791 Bochum, Germany.
authors: Anke
authors: A
authors: Stroet
authors: Nadine
authors: N
authors: Trampe
authors: Andrew
authors: A
authors: Chan
keywords: CB1 receptor; cannabinoids; multiple sclerosis; nabiximols; secondary progressive multiple sclerosis; spastic tetraparesis; symptomatic treatment
references: Cochrane Database Syst Rev. 2003;(4):CD001332
references: 14583932
references: Eur J Neurol. 2011 Sep;18(9):1122-31
references: 21362108
references: Neurol Res. 2010 Jun;32(5):451-9
references: 20307378
references: Br J Pharmacol. 2008 Jan;153(2):199-215
references: 17828291
references: Eur J Neurol. 2007 Mar;14(3):290-6
references: 17355549
references: Lancet Neurol. 2010 Dec;9(12):1182-1199
references: 21087742
references: Neurology. 2006 Oct 24;67(8):1495-6
references: 17060585
references: J Physiol. 2002 Oct 15;544(2):459-67
references: 12381818
references: Mult Scler. 2006 Oct;12(5):639-45
references: 17086911
references: J Neuropsychiatry Clin Neurosci. 2008 Winter;20(1):36-51
references: 18305283
references: Ther Adv Neurol Disord. 2009 Nov;2(6):42-9
references: 21180629
references: Int J Obes (Lond). 2006 Apr;30 Suppl 1:S13-8
references: 16570099
references: Ther Adv Neurol Disord. 2012 Sep;5(5):255-66
references: 22973422
references: Mult Scler. 2010 Jun;16(6):707-14
references: 20558502
references: Clin Neuropharmacol. 2009 Jan-Feb;32(1):41-7
references: 18978501
references: Expert Opin Drug Saf. 2011 Sep;10(5):675-85
references: 21542664
references: Med Hypotheses. 2006;66(2):234-46
references: 16209908
references: J Neurosurg. 1993 Oct;79(4):544-9
references: 8410224
references: J Neurol Neurosurg Psychiatry. 2005 Apr;76(4):459-63
references: 15774425
references: Immunol Res. 2011 Oct;51(1):26-38
references: 21626285