Advances in the management of multiple sclerosis-related spasticity

Multiple sclerosis (MS) is a disabling and highly symptomatic disease that runs a progressive course. Spasticity is a common symptom that it is often painful, reduces mobility, disturbs sleeping patterns and can lead to individuals requiring extensive nursing care. It is a major cause of disability, which negatively impacts the individual’s well-being and quality of life, and disrupts family unity. Spasticity can be ameliorated by a number of classical general antispastic agents, but a systematic review undertaken by the Cochrane Group concluded that the overall benefit of such drugs was small [1]. In recent years, research efforts have focused on the endocannabinoid system as a therapeutic target for MS-related spasticity, since it has been shown to be involved in the modulation of neurotransmission at inhibitory and excitatory synapses in the brain. The stimulus for this research resulted from the positive benefits reported for herbal street cannabis in patients with disorders such as MS and various pain syndromes.

In this satellite symposium our expert speakers review the most recent clinical evidence available for Sativex^® (nabiximols, USAN name), a first-in-class endocannabinoid system drug, whose main active ingredients are the cannabinoids, tetrahydrocannabinol and cannabidiol. Sativex was designed to exploit the positive therapeutic benefits of cannabis whilst minimizing possible negative effects associated with psychoactivity. For all medicines an optimal balance between benefit and risk is an important prerequisite. For cannabinoid medicines, there is the added dimension of allaying patient and family fears regarding dependence/addiction and possible legal concerns.

We are seeing some significant advances in the longer term treatment of MS, which is reflected in increased longevity and decreased mortality. With patients living longer, management of symptoms will become more and more important. Undoubtedly, spasticity is one of the most important symptoms in this regard and, research involving cannabinoid medicines and the endocannabinoid system is an important step forward.

Financial & competing interests disclosure

For full financial and competing interests disclosure please see the Contents page.