title: Sativex in the management of multiple sclerosis-related spasticity: role of the corticospinal modulation.
abstract: Sativex is an emergent treatment option for spasticity in patients affected by multiple sclerosis (MS). This oromucosal spray, acting as a partial agonist at cannabinoid receptors, may modulate the balance between excitatory and inhibitory neurotransmitters, leading to muscle relaxation that is in turn responsible for spasticity improvement. Nevertheless, since the clinical assessment may not be sensitive enough to detect spasticity changes, other more objective tools should be tested to better define the real drug effect. The aim of our study was to investigate the role of Sativex in improving spasticity and related symptomatology in MS patients by means of an extensive neurophysiological assessment of sensory-motor circuits. To this end, 30 MS patients underwent a complete clinical and neurophysiological examination, including the following electrophysiological parameters: motor threshold, motor evoked potentials amplitude, intracortical excitability, sensory-motor integration, and Hmax/Mmax ratio. The same assessment was applied before and after one month of continuous treatment. Our data showed an increase of intracortical inhibition, a significant reduction of spinal excitability, and an improvement in spasticity and associated symptoms. Thus, we can speculate that Sativex could be effective in reducing spasticity by means of a double effect on intracortical and spinal excitability.
authors.affiliation: IRCCS Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS 113, 98124 Messina, Italy.
authors.forename: Margherita
authors.identifier: 0000-0002-0730-8118
authors.initials: M
authors.lastname: Russo
authors.affiliation: IRCCS Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS 113, 98124 Messina, Italy.
authors.forename: Rocco Salvatore
authors.initials: RS
authors.lastname: Calabrò
authors.affiliation: IRCCS Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS 113, 98124 Messina, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Naro
authors.affiliation: IRCCS Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS 113, 98124 Messina, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Sessa
authors.affiliation: IRCCS Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS 113, 98124 Messina, Italy.
authors.forename: Carmela
authors.identifier: 0000-0003-4693-7264
authors.initials: C
authors.lastname: Rifici
authors.affiliation: IRCCS Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS 113, 98124 Messina, Italy.
authors.forename: Giangaetano
authors.initials: G
authors.lastname: D'Aleo
authors.affiliation: IRCCS Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS 113, 98124 Messina, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Leo
authors.affiliation: IRCCS Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS 113, 98124 Messina, Italy.
authors.forename: Rosaria
authors.initials: R
authors.lastname: De Luca
authors.affiliation: Department of Neurosciences, University of Messina, Messina, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Quartarone
authors.affiliation: IRCCS Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS 113, 98124 Messina, Italy.
authors.forename: Placido
authors.identifier: 0000-0003-0394-8166
authors.initials: P
authors.lastname: Bramanti
mesh_terms: D002185:Cannabidiol; D063386:Cannabinoid Receptor Agonists / Q000494:pharmacology / Q000627:therapeutic use*; D002540:Cerebral Cortex / Q000503:physiopathology; D013759:Dronabinol; D004338:Drug Combinations; D019054:Evoked Potentials, Motor; D006801:Humans; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000503:physiopathology; D009128:Muscle Spasticity / Q000503:physiopathology / Q000517:prevention & control*; D009433:Neural Inhibition / Q000187:drug effects; D010936:Plant Extracts / Q000494:pharmacology / Q000627:therapeutic use*; D011712:Pyramidal Tracts / Q000503:physiopathology*; D066191:Sensorimotor Cortex / Q000503:physiopathology; D050781:Transcranial Magnetic Stimulation
chemical_list: D063386:Cannabinoid Receptor Agonists; D004338:Drug Combinations; D010936:Plant Extracts; D002185:Cannabidiol; D013759:Dronabinol; C587251:nabiximols