Clinical case reviews in multiple sclerosis spasticity: experiences from around Europe

Abstract

Spasticity is one of the main symptoms associated with multiple sclerosis (MS). Epidemiological studies indicate that approximately two-thirds of MS patients experience spasticity and, in a relevant proportion of this group, spasticity is moderate to severe. Yet, spasticity remains largely undertreated. The most commonly used oral antispasticity agents (e.g., baclofen, tizanidine, gabapentin) generally do not reduce spasticity adequately at dosages that are well tolerated by patients. This review of MS spasticity cases from around Europe presents current knowledge of considerations for administration of a new agent (tetrahydrocannabinol/cannabidiol-based nabiximols [Sativex®] oromucosal spray) for management of MS spasticity, with the aim of ensuring appropriate and optimal use for best outcomes. Assessment of the European clinical experience is intended to provide a better understanding of the prescribing regulations for MS spasticity treatments, facilitate identification of suitable candidate patients for Sativex and increase awareness of alternative management approaches for MS-related spasticity.

Keywords::

• clinical cases
• management
• multiple sclerosis
• nabiximols
• Sativex
• spasticity
• symptomatic treatment

Acknowledgements

J Koehler wrote the section ‘Clinical experience with use of Sativex in Germany’. MP Amato wrote the section ‘Clinical experience with use of Sativex in Italy’. C Oreja-Guevara wrote the section ‘Clinical experience with use of Sativex in Spain’. J Lycke wrote the section ‘Clinical experience with use of Sativex: perspective of other European countries’. The authors would like to thank the following investigators for providing patient cases for Table 4: L Landete Pascual, Hospital Universitario Doctor Peset, Valencia, Spain (Case 1); T Ayuso Blanco, Y Pisón Cadarso, Complejo Hospitalario de Navarra, Pamplona, Spain (Case 2); MC Calles- Hernández, Hospital Universitario Son Espases, Palma de Mallorca, Spain (Case 3). The authors would also like to thank the following investigators for providing the patient cases for Table 5: R Blasco-Quilez, Hospital Puerta de Hierro Majadahonda, Madrid, Spain (Case 1); V de las Heras-Revilla, Hospital Universitario Infanta Sofia, S Sebastián de los Reyes, Madrid, Spain (Case 2); A Miralles-Martinez, Hospital Universitario Infanta Sofia, S Sebastián de los Reyes, Madrid, Spain (Case 3). The authors would also like to thank the following investigators for providing the patient cases for Table 6: J Mallada Frechín, Hospital General Universitario Virgen de La Salud, Elda, Alicante, Spain (Case 1); V Meca Lallana, Hospital Universitario de la Princesa, Madrid, Spain (Case 2); FC Pérez Miralles, M Escutia Roig, B Casanova Estruch, Hospital Universitari i Politècnic La Fe, Valencia, Spain (Case 3).

Financial & competing interests disclosure

J Koehler has received honoraria or consultation fees or support of scientific events from Almirall, Bayer, BiogenIdec, Merck Serono, Novartis Pharma, Sanofi Aventis and TEVA. J Lycke has received grant research/support from Biogen Idec and Novartis, honoraria from Almirall S.A., Biogen Idec, Novartis, Sanofi-Aventis, Teva, and has taken part in speaker bureaus for Almirall S.A., Biogen Idec, Novartis, Sanofi-Aventis and Teva. J Koehler, MP Amato, C Oreja-Guevara and J Lycke received honoraria from Laboratorios Almirall, S.A. (Barcelona, Spain) for participating in the symposium and producing this supplement article. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Writing assistance was provided by Content Ed Net with funding from Laboratorios Almirall, S.A., Barcelona, Spain.