title: Upper motor neuron evaluation in multiple sclerosis patients treated with Sativex®.
abstract: 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).
  
  
  OBJECTIVE
  To assess CST impairment in MS patients with and without spasticity and to evaluate its evolution under Sativex®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®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®clinical effect.
authors: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy.
authors: A
authors: A
authors: Carotenuto
authors: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy.
authors: R
authors: R
authors: Iodice
authors: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy.|Department of Neurology, Radiology, Neuroscience, Icahn School of Medicine, Mount Sinai, NY, USA.
authors: M
authors: M
authors: Petracca
authors: Department of Neurology, Radiology, Neuroscience, Icahn School of Medicine, Mount Sinai, NY, USA.
authors: M
authors: M
authors: Inglese
authors: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy.
authors: I
authors: I
authors: Cerillo
authors: Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
authors: S
authors: S
authors: Cocozza
authors: Department of Neurology, Icahn School of Medicine, Mount Sinai, NY, USA.
authors: C
authors: C
authors: Saiote
authors: Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
authors: A
authors: A
authors: Brunetti
authors: Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
authors: E
authors: E
authors: Tedeschi
authors: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy.
authors: F
authors: F
authors: Manganelli
authors: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy.
authors: G
authors: G
authors: Orefice
mesh_terms: D000328:Adult; D002185:Cannabidiol; D013759:Dronabinol; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000187:drug effects; D009103:Multiple Sclerosis / Q000150:complications / Q000188:drug therapy*; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D010936:Plant Extracts / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D011712:Pyramidal Tracts / Q000187:drug effects
chemical_list: D004338:Drug Combinations; D010936:Plant Extracts; D002185:Cannabidiol; D013759:Dronabinol; C587251:nabiximols
keywords: Sativex; corticospinal tract; electrophysiological assessment; multiple sclerosis; spasticity